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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This job posting is no longer active.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 Revenue Integrity 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) as well as complex payor denials/audits. Assists with appealing coding denials. Works with departments on charging and coding issues. Possesses 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.

Responsibilities:

  • 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 Care.
  • Audits the accuracy of charges based on third party audit requests and document 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 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:

  • If Bachelor’s Degree in an appropriate discipline: Three (3) years of experience with an emphasis on Hospital coding, billing, auditing, compliance, charging and/or revenue integrity.

  • If an Associates Degree in an appropriate discipline: Seven (7) years of experience with an emphasis on Hospital coding, billing, auditing, compliance, charging and/or revenue integrity.
  • If a High School Diploma or GED: Eleven (11) years of experience with an emphasis on Hospital coding, billing, auditing, compliance, charging and/or revenue integrity.

Knowledge, Skills, And Abilities Requirements:

  • Ability to research complex coding and regulatory requirements in order to understand and analyze payer regulations as well as coding guidelines
  • Extensive knowledge of Correct Coding Initiative (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, dynamic, project-oriented environment; Proficient in time management with superior prioritization skills
  • Self-motivated and detail oriented with strong analytical and critical-thinking skills
  • Effective verbal and written communication skills with the ability to professional present information to all levels of management
  • Understanding of overall hospital revenue cycle functions.

Preferred Skills/Experience:

  • Previous Revenue Cycle experience preferred
  • Epic HB Resolute experience preferred
  • AHIMA/AAPC National Coding Certification preferred
  • Intermediate Excel experience preferred
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.

Equal Employment Opportunity

UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.

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