Revenue Integrity Analyst

Revenue Integrity Analyst

Resolves billing issues, and provides coverage guidelines for billable services to reduce or prevent future claim denials. Employs Craneware Online, EPIC WQ workflows, and other accredited resources for assigned cost center(s) to identify potential reimbursement opportunities in a proactive manner. Ensures the appropriate bundling or unbundling of charges, and applicable modifiers applied so that all charges that are submitted result in optimal reimbursement while following applicable billing, coding and reimbursement regulations within respective areas. Interacts with other departmental staff, i.e. BO, HIM and ADT for resolution of third party payer billing disputes. Additionally, resolves CCI edits as appropriate, reviews Medicare intermediary and other third party payer bulletins to keep current on billing requirements and APC payment status and changes. Communicates relevant information to all applicable department personnel. Communicates results through daily interaction and monthly status meeting to the department team. Provides other support as needed.

Degree/Diploma Obtained Program of Study Required/ Preferred and/or High School Diploma or Equivalent Required Additional Requirements Prefer Bachelor Degree or higher formal education, 2 years formal education post high school in clinical, financial, or coding program. Experience Requirements Minimum Years Required Area of Experience Required/ Preferred and/or 3 Years Healthcare Required Additional Requirements 3 experience in healthcare-related field, in hospital billing, coding and/or charging/reimbursement-related capacity. Additional clinical experience in related field a plus. State of Florida Licensure Requirements Licenses Required/ Preferred and/or Not Required Certifications/Registration Requirements Certificates/Registrations Required/ Preferred and/or Additional Requirements Coding certification preferred to include CPT, HCPCS, ICD9-10, and DRG