Revenue Integrity Analyst

Location: Remote - Florida

Department: Department of Revenue Integrity

Work Type: Full Time

Shift: Shift 1/7:00:00AM to 3:30:00AM

Minimum to Midpoint Pay Rate:$22.78 - $29.62 / hour

Summary

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.

Requirements

Educational Requirements

Degree/Diploma ObtainedProgram of StudyRequired/
Preferredand/orHigh School Diploma or EquivalentRequired

Additional Requirements

Prefer Bachelor Degree or higher formal education, 2 years formal education post high school in clinical, financial, or coding program.

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Experience Requirements

Minimum Years RequiredArea of ExperienceRequired/
Preferredand/or3 YearsHealthcareRequired

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.

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State of Florida Licensure Requirements

LicensesRequired/
Preferredand/orNot Required

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Certifications/Registration Requirements

Certificates/RegistrationsRequired/
Preferredand/or

Additional Requirements

Coding certification preferred to include CPT, HCPCS, ICD9-10, and DRG

US:FL:Fort Myers