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REGULATORY INTEGRITY ANALYST - RC SS HIM REVENUE INTEGRITY

Email Job Job ID: AUD000HW

Job Description

This position may involve support of various hospitals and health care systems within the UNC Health Care System, but will be employed by Rex Hospital, Inc. (this includes, but is not limited to, for purposes of payroll, health benefits, retirement options, and applicable policies). Employees of an entity managed by UNC Health Care are external candidates and will be employed by Rex Hospital, Inc. if selected for the role.

  • Maintains an environment of safety for patients, self and others. 
  • Researches, resolves, educates and acts as a liaison with Patient Financial Services, Financial Systems Support, and Patient Care Services regarding the Outpatient Correct Coding Initiative (CCI) edits that suspend in the Patient Accounting SSI software and ensures that only appropriate codes are grouped. 
  • Monitors, resolves and educates departments on Outpatient claims for ancillary services reported in duplicates and/or multiple quantities. 
  • Develops and administers audit program to focus on presence/absence and accuracy of charges as compared to documentation in the patient's medical record and the information ultimately listed on the UB-92 and/or HCFA-1500. 
  • Develops a full understanding of application system(s) and their appropriate use in the coding, billing, order entry and financial process of Rex Healthcare. 
  • Provides input to the Health Information Management Director on policies and procedures to enforce Corporate Compliance regulations and Center for Medicare/Medicaid Services (CMS) guidelines, decision making, and problem solving activities related to compliance programs administered and coordinated by HIM. 
  • Develops and maintains a comprehensive understanding of the Ambulatory Payment Classification (APC) reimbursement methodology and grouping logic for all Outpatient ancillary departments. 
  • Conducts investigations, communicates, educates and works with and/or leads action teams to troubleshoot issues identified through the charge/chart audit process and/or through compliance research and/or audit findings. 
  • Develops, coordinates, monitors and evaluates coding and documentation practices for the Hospitalist, and other hospital based physician programs, consistent with all official regulatory guidelines. 
  • Coordinates and performs the audit and educational/feedback activities for the Hospitalist, and other hospital based physician programs. 
  • Conducts investigations, communicates, educates and works with and/or leads action teams to troubleshoot issues identified through the audit process and/or through compliance research. 

Qualifications

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).


If a High School diploma or GED: Ten (10) years of acute healthcare experience with an emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.


If an Associate's degree: Six (6) years of acute healthcare experience with an emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.


If a Bachelor's degree: Two (2) years of acute healthcare experience with an emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.

Primary Location: Chapel Hill, North Carolina, United States

Department: SHRD-76030-RC SS HIM REVENUE INTEGRITY

Shift: Day Job

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