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Revenue Integrity Analyst - HIM Revenue Integrity

This job posting is no longer active.

Job ID: 5269
Location: Raleigh, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

The Regulatory Compliance analyst is responsible for researching and resolving complex carrier/payor claim edits, including but not limited to Correct Coding Initiative (CCI), Medically Unlikely Edits (MUEs) and Medically Acceptable Units (MAUs) as well as complex payor denials/audits. Assists with appealing coding denials. Works with departments on charging and coding issues. They possess claims coding (including modifiers)/reimbursement/billing and compliance skills to access, review and analyze charges and coding to ensure claims are compliant according to payor specifications prior to claim submission.

Responsibilities:

  • Conducts investigations, communicates, educates and works with and/or leads action teams to troubleshoot issues identified through the charge/chart audit process and/or compliance research and/or audit findings.
  • 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 in the billing system.
  • Develops and maintains a comprehensive understanding of the Ambulatory Payment Classification and IPPS reimbursement methodology and grouping logic for all services.
  • Develops full understanding of applications system and their appropriate use in the documentation for coding, billing, order entry and financial process of UNC Health Care.
  • Develops, coordinates, monitors and evaluates coding and documentation practices for the hospital based clinical departments consistent with all official regulatory guidelines.
  • Monitors, resolves and educates departments on claims for services reported in duplicates and/or multiple quantities such as MAUs and MUEs.
  • Provides input to the Health Information Management and Patient Financial Services Director or designee on policies and procedures to enforce compliance regulations and CMS guidelines, decision making and problem solving activities related to compliance programs administered and coordinated by Health Information Management and Patient Financial Services.
  • Researches, resolves, educate and act 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.

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).
  • 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.
  • 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 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.

Preferred Coding Certification in one of the following:

  • CCS
  • CPC
  • RHIA
  • RHIT



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. This is not a State employed position.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

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