The Revenue Integrity Analyst will have full responsibility to review Outpatient Line-Item Denials generated by LCD/NCDs or other NCCI/MUE edits as well as the patient chart in order to resolve the denial.

Familiarity with Medicare OPPS and the APC Grouper a must. Experience with Medicare DDE/FISS/Omni a plus.

Proficiencies:

Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, Ras, 1500 claim forms as well as code data sets to include CPT, HCPCS, and ICD 10. Comprehensive knowledge of NCCI edits, and Medicare LCD/NCDs along with a complete understanding of reimbursement theories to include DRG, OPPS, HCC, and health care compliance. Must have exceptional understanding of medical terminology, anatomy and physiology along with clinic department activities. Capacity to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with facilitating to all member entities. Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing personnel.

· Reviews selected medical records documentation to determine accuracy of coding assignments, billing compliance, medical necessity and when appropriate collaborate with shared coding and financial departments to identify departments that require improved documentation.

· Provides feedback to providers regarding missing, incomplete, unspecific, unclear or conflicting documentation.

· Develop corrective action plans for resolution of denials

· Tracks improvements of targeted denials once process, or system edits have developed to reduce/prevent future denials

· Identifies and prepares charges to be corrected on accounts

· Pre-reviews accounts being audited by Government Agencies

· Organizes and reconciles daily work drivers to ensure accountability of all audits assigned and to ensure audits are worked in proper priority.

· Maintains current knowledge on various billing rules to ensure charges that are identified in audits are split and rebilled properly

· Conducts trend analyses to identify patterns in audit requests and outcomes for medical necessity, coding and billing practices.

· Performs ancillary service quality assurance reviews and audits and provides feedback and education

· Recommends solutions to improve charge capture accuracy.

· Excellent communication skills necessary to deal with many departments regarding billing issues and required solutions.

· Performs other duties as assigned.

Job Type: Full-time

Pay: $25.00 - $35.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)
• LCD/NCD Edits: 3 years (Required)

License/Certification:

• CCS or CPC Credentials (Required)

Work Location: Remote

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