Revenue Integrity Specialist

Overview
Responsible for charge capture analysis, workflow and maintenance of related work queues in assigned service lines. Works designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and application of payer guidelines. The position will evaluate and provide guidance related to billing and/or clearinghouse system edits. May complete focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
Responsibilities
Responsible for charge capture analysis, workflow and maintenance of related work queues in assigned service lines. Works designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and application of payer guidelines. The position will evaluate and provide guidance related to billing and/or clearinghouse system edits. May complete focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
Qualifications
Education
H.S. Diploma or General Education Degree (GED) Required
Associate's Degree in HIM/HIT Preferred or
Bachelor's Degree in HIM/HIT Preferred
Work Experience
3 years of related healthcare experience focused in one or more of the following areas: charge integrity Required
charge capture/reconciliation Required
healthcare compliance Required
charge auditing Required
CDM management Required
coding and/or hospital billing procedures Required
Experience working with Epic Required
Licenses and Certifications
AHIMA certification (e.g. RHIA, CCS, RHIT) Upon Hire Required or
RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure RN licensure Upon Hire Required or
certified healthcare provider (e.g. MT, RT) Upon Hire Required
AAPC certification (e.g. CPC, CPH, CA)
Business Unit : Company Name:
Piedmont Healthcare Corporate

Work arrangement
Yes