Revenue Integrity Specialist

Overview

This remote position will help to support billing edit resolution activities for the Laboratory, Pathology and Blood Bank services lines.

Candidates with hands‑on experience working with claim edits, specifically within Laboratory, Pathology and Blood Bank service lines are preferred.

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 clearinghouse system edits. May 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 time frames.

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.

• H.S. Diploma or General Education Degree (GED) Required
• Associates Degree in HIM/HIT Preferred or
• Bachelors Degree in HIM/HIT Preferred

• 3 years of related healthcare experience focused in one or more of the following areas: charge integrity Required
• charge capture/reconciliation Required
• healthcare compliance Required
• charge auditing Required
• CDM management Required
• coding and/or hospital billing procedures Required
• Experience working with Epic Required

• AHIMA certification (e.g. RHIA, CCS, RHIT) Upon Hire Required or
• RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure RN licensure Upon Hire Required or
• certified healthcare provider (e.g. MT, RT) Upon Hire Required