WM
Revenue Integrity Specialist
Contract type
Ongoing
Work mode
Remote · United States
Experience
Mid-level · 2+ years
Job description
Reviews charge review, claim, and denial edits to ensure compliance with CCI, OCE, MUE claim edits and LCD & NCD billing rules while maximizing reimbursement. Works with Revenue Cycle leadership on the development, testing, implementation, maintenance and optimization of Epic's Revenue Guardian module and/or other related claim editing software.
At a glance
- Employment
- Full-time · Employee (employment agreement)
- Work mode
- Remote · United States
What you'll do
- Manages payor and claim CCI, OCE, MUE, LCD and NCD edits in a timely, accurate and compliant manner.
- Tracks edited accounts, correspondence, actions, and outcomes as well as coordination of activities and follow-up for payor and claim edits; reports trends to Revenue Cycle Leadership.
- Monitors, analyzes and reports on denials appeals and follow-up activities related to billing edits.
- Provides assistance to departments regarding compliance with government regulations, when requested as it relates to claim edits.
- Works with revenue cycle leadership, chargemaster committee, and clinical departments (when required) to ensure optimal charge capture for services provided.
- Maintains up to date knowledge of payer policies and government regulations to ensure compliant and accurate billing processes; communicates relevant information to revenue cycle leadership.
- Performs root-cause analysis for high volume edits to reduce the incidence of non-billable charges; works with technical Epic team to correct any technical error causing incorrect charge routing and clinical departments and/or HIM on missed charges.
- Reports on the volume of claim edits to leadership with the goal of reducing the volume of edits occurring over time and to quickly identify any new claim errors that begin with updated policies.
- Performs claims reviews ensuring that record documentation supports charges captured.
- Provides support and assistance to Revenue cycle Leadership as needed.
- Prioritizes work to effectively reduce volume and meet payer appeal deadlines.
What we're looking for
- High School Diploma or equivalent.
- Two (2) years of billing- revenue cycle experience.
- Must be capable of using computers effectively.
- Knowledge of medical terminology, ICD-10, CPT & HCPCS codes.
- Analytical, critical thinking and clear, concise communication skills are required to interact effectively with all levels of management.
- Must be capable of using copier/fax effectively.
- Good analytical skills including the use of Microsoft Excel and reporting tools.
- Good communication skills and professional demeanor required.
- Understanding of payor clinical reimbursement policies and government regulations.
- Understanding of ACP/MPFS payment structures and other third-party payment methodologies.
Nice to have
- Bachelor's degree in business or other healthcare related field or Health Information Technology graduate.
Your team
SYSTEM Patient Financial Services
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About WVU Medicine
Key facts
- Company: SYSTEM West Virginia University Health System
- Cost Center: 544 SYSTEM Patient Financial Services
- Scheduled Weekly Hours: 40
- United States of America (Non-Exempt)