UNC Health · 4 hours ago

Revenue Integrity Analyst-HIM Revenue Integrity

Raleigh, NC

Full-time

Remote

Mid Level

$24.13/hr - $34.70/hr

3+ years exp

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Responsibilities

Researches and resolves complex carrier/payor claim edits, including but not limited to Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs) as well as complex payor denials/audits.

Possess claims coding, reimbursement, and billing skills to review and analyze charges and coding to ensure claims are compliant according to payor specifications prior to claim submission.

Develops full understanding of application systems and their appropriate use in the documentation for charging, billing, order entry and financial process of UNC Health System

Audits the accuracy of charges based on third party audit requests and document findings in internal audit system.

Review observation cases to accurately capture observation hours and infusion charges.

Collaborates with departments on charging and coding issues.

Researches, resolves, and initiates the Medicare Part A/Part B process.

Identifies and troubleshoots charge issues and opportunities for charge/process enhancements.

Researches, resolves, educates and act as a liaison with Patient Financial Services, Health Information Management and hospital based clinical departments regarding the Correct Coding Initiative (CCI) edits that suspend in claims software and ensures that only appropriate codes are grouped.

Qualification

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Claims codingBillingCorrect Coding Initiative (CCI)Medically Unlikely Edits (MUEs)CPTHCPCSICDRevenue CodesModifiersHospital revenue cycleCritical-thinking skills

Required

Bachelor’s degree in an appropriate discipline, completion of an accredited Record Technician program or an AHIMA independent study program (or equivalent combination of education, training and experience).

If a Bachelor's degree: Three (3) years of acute healthcare experience with an emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.

If an Associate's degree: Seven (7) years of acute healthcare experience with an emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.

If a High School diploma or GED: Eleven (11) years of acute healthcare experience with an emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.

Ability to research complex coding and regulatory requirements in order to understand and analyze payer regulations as well as coding guidelines.

Extensive knowledge of Correct Coding Initiative (CCI) edits, CPT, HCPCS, ICD, Revenue Codes, modifiers, billing, regulations and guidelines (Medicare, Medicaid, third-party billing rules, coverage, and payment) required.

Results oriented with the ability to meet deadlines in a fast-paced, dynamic, project-oriented environment; Proficient in time management with superior prioritization skills.

Must be self-motivated and detail oriented with strong analytical and critical-thinking skills.

Effective verbal and written communication skills with the ability to professional present information to all levels of management.

Understanding of overall hospital revenue cycle functions.