Job Summary :

The Revenue Integrity Coordinator reviews and revises accounts to achieve revenue enhancement and billing/coding compliance. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing. The incumbent identifies patterns for educational opportunity, researches coding questions, and tracks audited cases.

Responsibilities:

Monitors various work queues and reports to identify pending charges and works to resolve issues. Researches coding errors to identify resolutions. Provides feedback to providers to correct errors. Recommend sound billing/coding best practices that are able to withstand audits. Foster continuous improvement of revenue cycle processes through education with various departments and trend analysis. Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered. Works within Cerner and within SSI to correct billing issues. Works with additional EMRs (Patient Keeper, Paragon) to review billing/coding. Performs periodic review of codes and works with patient billing regarding bundling and unbundling services as delineated in CMS and CCI edits. Researches technical guidance in CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance. Maintains and provides information on status of audits and issues presented. Works on special projects as required. Participates in required regulatory change implementations and ongoing monitoring related to compliant charge capture. Performs other duties as assigned.

Qualifications/Requirements:

Experience:

Minimum two years clinical experience in a healthcare setting, Preferred experience in Excel and Electronic Medical Records experience.

Education:

High School Diploma required. Associate's Degree preferred or two years' work experience. Licenses /

Certifications:

Certified Professional Coder (CPC) or similar credential, preferred.

Other:

Familiarity with medical record documentation standards and practices, health care insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and

ICD-10-CM

codes is preferred.

Special Requirements:

Requires travel to other WMCHealth Facilities.