REV INTEGRITY SPECIALIST - REVENUE INTEGRITY
Status: Full Time
Shift: 40 hours per week including rotating/regular weekend shifts
Exempt: No
Summary:
Responsible for reviewing and posting charges in a manner that is timely, accurate, and compliant to all billing regulations.Responsible for departmental chargemaster functions.Responsible for ensuring that clinical personnel and departments implement the appropriate charge capture process.Responsible for partnering with clinical personnel and departments to support revenue cycle.
Other information:
1.Previous Experience:
Charge posting/auditing, HCPCS/CPT coding, billing charges, or clinical experience within health system is preferred. Proficiency in Epic is preferred. Proficiency in Microsoft Office including Excel and Word is required. Strong communication skills and strong analytical skills are required.
2.Specialized or Technical Education Required:
High school diploma with 3 years healthcare clinical knowledge/experience or high school diploma with completion of billing/coding program or Bachelor’s degree in Accounting, Finance, or related field.
3.Manual or Physical Skill Required:
Proper vision, hearing, and body mechanics to operate computers, telephone, and other office equipment;to spend long hours sitting and working with computer;to occasionally walk between various departments;and to occasionally lift files or papers weighing up to 10 lbs.
4.Physical Effort Required/Physical Demands:
Strength:Sedentary
Push:Occasionally
Pull:Occasionally
Carry:Occasionally
Lift:Occasionally
Sit:Constantly
Stand:Occasionally
Walk:Occasionally
Responsibilities:
1.Submit and post all charges appropriately, accurately, and timely.
2.Analyze patient’s chart and interpret clinical documentation for services performed. Determine applicable charges, HCPCS/CPT codes, and modifiers. Ensure the appropriate charges are captured and have sufficient and proper documentation.
3.Must be able to understand the relationship between documentation, charges, and billing guidelines and be able to link the charges on the bill with the documentation in patient’s chart.
4.Develop an understanding of the operations, system processes, and procedures used in the department of North Oaks.
5.Review and analyze charges, charge edits, DNB/stop bills, and/or claim edits and make corrections as necessary and timely
6.Work with other revenue cycle departments in evaluating and correcting charging issues and denials.
7.Perform regular charge audits to ensure accurate documentationand charges in accordance with applicable regulatory guidelines, compliance policies and standards.
8.Report any trend in charge opportunities. Collaborate with IT and clinical departments on charging improvements.
9.Review bulletins, charging manuals, and HCPCS/CPT guideline and provide feedback to Supervisor.Communicate updates to applicable clinical departments.
10.Understand and stay updated of chargemaster functionality. Submit request for charge revision, addition, and deletion.
11.Act as a liaison to physicians, nursing staff, and clinical departments in charging activities, chargemaster functions, bulletins, and staff education.
12.Cross-train with other Revenue Integrity Specialists and serve as back-up for one another when needed.
13.Responsible for compliance with all payors’ regulations in regards to charges.
14.Obtain and maintain up-to-date knowledge of HCPCS/CPT coding including revenue code, HCPCS/CPT code, and modifier.
15.Obtain and maintain up-to-date proficiency in Epic applications related to charges and charge edits.
16.Perform other duties as assigned.
17.Follows North Oaks Health System's compliance programs and all federal and state regulatory guidelines.
