Revenue Integrity Specialist - Atlanta, United States - Grady Health System

Grady Health System Atlanta, United States

2 weeks ago

Description

External Description

This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process.

It is a holistic approach that guides the organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. Responsible for charge capture analysis, workflow and maintenance of related work queues in assigned service lines.

Works designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and application of payer guidelines.

The position will evaluate and provide guidance related to billing and/or claim edits.

Complete focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.

Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.

Responsiblities:
Performs other miscellaneous duties as assigned. Perform daily charge reconciliation (hospital). Responds to departmental charging inquiries timely. Provide support for assigned cost centers within service lines and in collaboration with your team. Serve as primary service line representative for all charge related inquiries and issues and proper usage of charge codes. Provide education to clinical departments on charge capture processes and workflows as needed.

Assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation.

Reviews patient records and is able to assist with account fixes, charge reconciliation for other departments based on clinical documentation.

Capture missed charges identified by Revenue Guardian. Expected to identify report and participate in the resolution of any potential or actual revenue/charge related issues. Monitor daily, weekly and monthly department revenue. Investigate large increases and/or decreases with department leadership.

Required:
High School Diploma or GED

Preferred:
Bachelor's degree in Finance, Accounting, or Healthcare related field

Required:
Two (2) or more years of job related experience including revenue integrity, coding, or billing

Preferred:
Four (4) or more years of job related experience including revenue integrity, coding or billing.

Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.
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