Revenue Integrity Analyst - HIM Revenue Integrity

Overview

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Summary: The Revenue Integrity Analyst is responsible for researching and resolving complex carrier/payor claim edits, including but not limited to Correct Coding Initiative (CCI) and Medically Unlikely Edits (MUEs), as well as complex payor denials/audits. Assists with appealing coding denials. Works with departments on charging and coding issues. Possess claims coding, reimbursement, and billing skills to review and analyze charges and coding to ensure claims are compliant according to payor specifications prior to claim submission.

• Researches and resolves complex carrier/payor claim edits, including but not limited to Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs), as well as complex payor denials/audits.
• Possess claims coding, reimbursement, and billing skills to review and analyze charges and coding to ensure claims are compliant according to payor specifications prior to claim submission.
• Develops full understanding of application systems and their appropriate use in the documentation for charging, billing, order entry and financial process of UNC Health System.
• Audits the accuracy of charges based on third party audit requests and documents findings in internal audit system.
• Review observation cases to accurately capture observation hours and infusion charges.
• Collaborates with departments on charging and coding issues.
• Researches, resolves, and initiates the Medicare Part A/Part B process.
• Identifies and troubleshoots charge issues and opportunities for charge/process enhancements.
• Researches, resolves, educates and acts as a liaison with Patient Financial Services, Health Information Management and hospital-based clinical departments regarding the Correct Coding Initiative (CCI) edits that suspend in claims software and ensures that only appropriate codes are grouped.

• Education Requirements: Bachelor’s degree in an appropriate discipline, completion of an accredited Record Technician program or an AHIMA independent study program (or equivalent combination of education, training and experience).
• Licensure/Certification Requirements: No licensure or certification required.
• Professional Experience Requirements: If a Bachelor's degree:
  Three (3) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues. If an Associate's degree:
  Seven (7) years. If a High School diploma or GED:
  Eleven (11) years.
• Knowledge/Skills/Abilities: Ability to research complex coding and regulatory requirements to understand and analyze payer regulations and coding guidelines; extensive knowledge of CCI edits, CPT, HCPCS, ICD, Revenue Codes, modifiers, billing, regulations and guidelines (Medicare, Medicaid, third-party billing rules, coverage, and payment) required; results-oriented with the ability to meet deadlines in a fast-paced environment; proficient in time management with prioritization; self-motivated and detail-oriented with strong analytical and critical-thinking skills;
  
  effective verbal and written communication; understanding of overall hospital revenue cycle functions.

• Legal
  
  Employer:
  
  NCHEALTH
• Entity: Shared Services
• Organization Unit: HIM Revenue Integrity
• Work Type: Full Time
• Standard Hours Per Week: 40.00
• Salary Range: $24.73 - $35.56 per hour (Hiring Range)
• Pay offers: determined by experience and internal equity
• Work Assignment Type: Remote
• Work Schedule: Day Job
• Location of Job: US:
  
  NC:
  
  Chapel Hill
• Exempt From Overtime: Exempt:
  Yes
• Additional: This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
• EEO Statement: Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
• Accommodation Info: UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.