Care New England
Revenue Integrity Specialist
Care New England, Providence, Rhode Island, us, 02912
Job Summary:
Responsible for complete and accurate charge capture through review of medical record documentation of clinical services and procedures to ensure data integrity. Performs charge reconciliation activity to ensure optimal charge capture in accordance with Medicare, Medicaid or Third Party payor guidelines. Classification systems include ICD-9-CM, CPT, HCPCS as well as other specialty financial systems required for charging, billing and reimbursement analysis. The Revenue Integrity Specialist may be a resource to coding, reimbursement, and departmental areas for questions related to charges, auditing and the charge master.
Duties and Responsibilities:
Review medical records to identify clinical services and procedures eligible for revenue capture and charge scrubbing.
Ensures all documented, eligible clinical services and procedures are available for selection in the charge master and initiates and tracks charge intervention forms.
Interacts with physicians to clarify and accurately document patient diagnostic and procedural information as charged.
Enters charge information into the computerized databases.
Ensures timely record availability by meeting established bill hold standards.
Demonstrates a comprehensive knowledge of procedures outlined in ICD-9-CM, CPT, Medicare billing and compliance guidelines and other appropriate classification systems.
Maintains and complies with policies and procedures for confidentiality of all patient records.
Acts as an expert resource.
Performs other related duties as assigned.
Requirements:
High School Diploma Required; Associate’s Degree Preferred.
Must have at least 3 years of hospital or surgical center coding or billing experience which in the last 5 years, charge master experience preferred.
Certification in a focused area of the revenue cycle preferred.
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Responsible for complete and accurate charge capture through review of medical record documentation of clinical services and procedures to ensure data integrity. Performs charge reconciliation activity to ensure optimal charge capture in accordance with Medicare, Medicaid or Third Party payor guidelines. Classification systems include ICD-9-CM, CPT, HCPCS as well as other specialty financial systems required for charging, billing and reimbursement analysis. The Revenue Integrity Specialist may be a resource to coding, reimbursement, and departmental areas for questions related to charges, auditing and the charge master.
Duties and Responsibilities:
Review medical records to identify clinical services and procedures eligible for revenue capture and charge scrubbing.
Ensures all documented, eligible clinical services and procedures are available for selection in the charge master and initiates and tracks charge intervention forms.
Interacts with physicians to clarify and accurately document patient diagnostic and procedural information as charged.
Enters charge information into the computerized databases.
Ensures timely record availability by meeting established bill hold standards.
Demonstrates a comprehensive knowledge of procedures outlined in ICD-9-CM, CPT, Medicare billing and compliance guidelines and other appropriate classification systems.
Maintains and complies with policies and procedures for confidentiality of all patient records.
Acts as an expert resource.
Performs other related duties as assigned.
Requirements:
High School Diploma Required; Associate’s Degree Preferred.
Must have at least 3 years of hospital or surgical center coding or billing experience which in the last 5 years, charge master experience preferred.
Certification in a focused area of the revenue cycle preferred.
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