Status (FT/PT): Full-Time
Shift: Day shift
Req ID: 55906
The Revenue Integrity Recovery Coordinator is responsible for performing in-depth analysis of patient clinical and billing data to identify documentation opportunities, coding improvements and denial prevention. Develops and implements action plans for denial prevention based on root cause analysis findings. Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. May be required to travel throughout the system.
Associate Degree is required or Bachelor’s degree required within 2 years of accepting position. Degree/area of study must be in a healthcare or finance related field. Bachelor’s Degree is preferred.
Five (5) or more years of experience in coding, billing, charge documentation, charge audit, or charge capture activities is required.
Licensure/certification is required as an RHIA, RHIT, CCS, CPC/COC, or equivalent
Demonstrated knowledge of clinical processes, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes, audits and billing.
Experience with coding, and auditing for physician practices required. RHC experience preferred.
Proficient with MS Excel, Word and PowerPoint. Experience with Cerner and Star billing systems, report or query writing preferred.
Experience with developing and presenting education to Physicians and clinical departments.
Working knowledge of third party payer rules and requirements.
Knowledge of Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS) and fee for services reimbursement models, as well as Inpatient, outpatient, and physician practice billing edits.
Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
Excellent communication skills and the ability to work collaboratively with other departments both clinical and non-clinical.
This position reports to the System Manager of Revenue Integrity, and will be responsible for working denials, performing audits, preparing education for improved documentation, and responding to payer audits.
Has working contact with Management, Physicians, and Clinical leaders throughout the system.
AGE OF PATIENTS SERVED
Cares for patients in the age category(s) checked below:
Neonatal (birth-1 mo) Young adult (18 yr-25 yrs)
Infant (1 mo-1 yr) Adult (26 yrs-54 yrs)
Early childhood (1 yr-5 yrs) Sr. Adult (55 yrs-64 yrs)
Late childhood (6 yrs-12 yrs) Geriatric (65 yrs & above)
Adolescence (13 yrs-17 yrs) All ages (birth & above)
X No direct clinical contact with patients