Hospital Revenue Integrity Specialist

Overview

ONE TEAM. ALL HEART. At Oklahoma Heart Hospital (OHH), patient care is at the heart of everything we do. This physician owned hospital was designed by cardiologists to ensure that patients receive expert, individualized care with utmost comfort. OHH offers a competitive benefits program to all team members from the first day of employment.

Top Tier Benefit Packages:

• Medical, Dental, and Vision

• 401 (k) plan

• Paid Time Off (PTO)

• Extended Medical Benefit (EMB)

Location: Business Office- 7800 NW 85th Terrace, OKC OK 73135

Shift: Full-Time, Days.

Responsibilities

The Hospital Revenue Integrity Specialist is responsible for evaluating charges for hospital claims against clinical documentation to identify missing, incorrect, or late charges. Evaluates charge capture processes to comply with government and non-government rules and regulations. Works pre-bill edits related to clinical documentation, to include CCI edits, MUEs, and billing edits. Facilitates a charge reconciliation program with clinical leadership and provides communication on missing or incorrect charges, and makes recommendations on best practice.

• Review all system and clearing house edits for potentially missing or incorrect charges or modifiers.

• Utilize EMR and clearinghouse to manage claim edits to preserve revenue and ensure all charges are added correctly based on clinical documentation.

• Validate claims data against payer rules and regulations, and provide clean claims within five days from discharge.

• Provide root cause analysis and feedback on incorrect charging practices. Consult and collaborate with adjacent departments to proactively prevent revenue leakage.

• Assist physicians in placing the correct procedure code for procedures when ordering or rendering services.

• Recommend system optimization to capture frequently missed or incorrect charges.

Qualifications

Education: High school graduate or equivalent preferred.

Experience: Minimum of two (2) years in Revenue Integrity, coding, charge entry, or billing (hospital setting preferred). Knowledge of CPT/HCPCS and ICD-10 coding. Cardiology experience is a plus. AHIMA or AAPC certification is preferred.