Inova Health System
Revenue Integrity Coding Analyst
Inova Health System, Fairfax, Virginia, United States, 22032
The Revenue Integrity Coding Analyst ensures accurate and complete assignment of codes, modifiers and case mix groupings (APC or DRG) that are supported by medical record documentation for inpatient and/or outpatient surgery records. Performs trend analysis and provides feedback for optimized workflow and problem resolution. Performs charge capture validation and billing data analysis in accordance with the Centers for Medicare & Medicaid Services regulations is of vital importance. Verifies billing data for accuracy and completeness while following all regulatory requirements in order to resolve edits or exceptions detected during system processing of Patient Accounting claims, SSI or the payer is essential. Conducts charge reviews on the appropriateness of patient charges and in accordance with the Charge Description Master and assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol and other applicable documentation. Facilitates medical necessity validation to ensure the timely and accurate processing of claims is expected.
Job Responsibilities
Ensures accurate and complete assignment of modifiers, CPT codes, and ICD-10CM diagnosis codes that are supported by medical record documentation for outpatient records.
Analyzes charge review findings and recommends to Revenue Cycle administration leadership in order to improve documentation, charging flow, and accuracy.
Reviews denial trends for documentation and charging opportunities and provides feedback on educational gaps.
Performs appropriate analytics as daily work queue management functions are performed.
Performs verification of billing data for accuracy and completeness.
Performs charge reviews by verifying billing data as compared to documentation and making corrections in patient accounting as needed.
Serves as a primary contact for charge and billing-related corporate-initiated charge reviews.
Ensures that modifiers applied are appropriate based upon reviews and/or makes necessary adjustments to patient account charges and/or balances. Evaluates the appropriateness of patient charges and Charge Description Master assigned HCPCS/CPT coding by reviewing medical records, facility protocol, and other applicable documentation.
Partners with the Billing team counterparts to determine how claim errors related to coding or charge review are resolved for purposes of accurate billing of claims for payment.
Reviews, monitors, and resolves claims.
Evaluates if account combinations and account splits are appropriately applied.
Analyzes accounts for specialized billing requirements that require a review of medical record documentation, regulatory information, and HCA standards.
Performs medical necessity validation required to ensure timely and accurate processing of claims.
Reviews Inova Health System registration communications, applicable Centers for Medicaid & Medicare Services transmittals, National Coverage Decisions, and Local Coverage Decisions.
Assesses impact on Revenue Integrity procedures and implement changes as needed.
Performs trend analysis and provides feedback for optimized workflow and problem resolution.
Performs appropriate analytics as daily work queue management functions are performed.
May perform additional duties as assigned.
Additional Requirements
Certification - One of the following Certified Coding Specialist Credentials: AAPC/AHIMA: RHIT, CCS, CPC, CPC-H, RHIALicensure - Not required
Experience - Five years of experience in coding
Education - Associate's Degree or equivalent experience in lieu of degree
Job Responsibilities
Ensures accurate and complete assignment of modifiers, CPT codes, and ICD-10CM diagnosis codes that are supported by medical record documentation for outpatient records.
Analyzes charge review findings and recommends to Revenue Cycle administration leadership in order to improve documentation, charging flow, and accuracy.
Reviews denial trends for documentation and charging opportunities and provides feedback on educational gaps.
Performs appropriate analytics as daily work queue management functions are performed.
Performs verification of billing data for accuracy and completeness.
Performs charge reviews by verifying billing data as compared to documentation and making corrections in patient accounting as needed.
Serves as a primary contact for charge and billing-related corporate-initiated charge reviews.
Ensures that modifiers applied are appropriate based upon reviews and/or makes necessary adjustments to patient account charges and/or balances. Evaluates the appropriateness of patient charges and Charge Description Master assigned HCPCS/CPT coding by reviewing medical records, facility protocol, and other applicable documentation.
Partners with the Billing team counterparts to determine how claim errors related to coding or charge review are resolved for purposes of accurate billing of claims for payment.
Reviews, monitors, and resolves claims.
Evaluates if account combinations and account splits are appropriately applied.
Analyzes accounts for specialized billing requirements that require a review of medical record documentation, regulatory information, and HCA standards.
Performs medical necessity validation required to ensure timely and accurate processing of claims.
Reviews Inova Health System registration communications, applicable Centers for Medicaid & Medicare Services transmittals, National Coverage Decisions, and Local Coverage Decisions.
Assesses impact on Revenue Integrity procedures and implement changes as needed.
Performs trend analysis and provides feedback for optimized workflow and problem resolution.
Performs appropriate analytics as daily work queue management functions are performed.
May perform additional duties as assigned.
Additional Requirements
Certification - One of the following Certified Coding Specialist Credentials: AAPC/AHIMA: RHIT, CCS, CPC, CPC-H, RHIALicensure - Not required
Experience - Five years of experience in coding
Education - Associate's Degree or equivalent experience in lieu of degree