Richmond, VA – 100% Remote Work
CREDENTIALED REVENUE INTEGRITY ANALYST – WORK FROM HOME
Work From Home Full Time
The Revenue Integrity Analyst (credentialed) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, 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 or exceptions detected during system processing of the claim in Patient Accounting, Relay Health or the payer.
Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances.
Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards.
Combines or splits accounts as appropriate.
Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities.
Provides charge review results and develops and coordinates educational in-services for facility staff related to charging/billing issues.
Coordinates retrospective, concurrent, patient requested, and external billing audits.
Reviews denial trends for documentation and charging opportunities.
Serves as a primary contact for charge related SSC and facility inquiries and issues.
Duties (included but not limited to)
Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. 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 and condition codes, as appropriate.
Identify charging, chargemaster coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues that are identified while working on edits.
Serve as charge master liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary
Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Revenue Integrity procedures and implement changes as needed.
Maintain billing education, attend webcasts and conference calls as required.
Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement.
Other duties as assigned.
High school diploma or GED required.
RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential; other healthcare related credential such as (but not limited to) LPN, LVN or RT
Healthcare experience in an acute care hospital or coding experience preferred.
Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews.
Active certification or licensure as a RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential; other healthcare related credential such as (but not limited to) LPN, LVN or RT
We offer training support, competitive salary and excellent benefits to include several insurance package options for Medical, Dental and Vision; Paid Time Off for vacation, sick leave and holidays, Employer-paid Short Term Disability, Company matching 401K and more!
Medical & Health , Medical Billing , Medical Coding