The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim.
Analyze and resolve specific billing edits and denials that require coding and billing expertise with some clinical knowledge that are delaying claims from processing in the Patient Accounting system; This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers, diagnosis codes as appropriate including charge corrections
Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary, Patient Financial Services, HIM, departments, etc. regarding charging and clinical documentation issues.
Participate as a member of the Revenue Integrity work group and report charging and medical necessity issues as appropriate.
Reports To: Supervisor, Revenue Integrity Specialist
Qualifications Education: High School diploma or GED required.Undergraduate degree preferred. Experience: Healthcare experience required. Clinical experience preferred Licensure, Certification, Registration: CCS, CCS-P, CPC, RHIT, RHIA is required. Licensed RN preferred Knowledge, Skills and Ability Requirements:
Excellent communication skills both verbal and written
Good interpersonal skills
Able to establish good customer relationships with trust and respect
Able to travel as needed
Computer skills: navigation and edit resolution through various Web based systems. Ability to use email, Excel, Word
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With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment. RegularStandard Hours:40Schedule:Full-time (40 hours)
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.