Revenue Integrity Coordinator

Job Title: Revenue Integrity Coordinator

Job Functions:

• Responsible for managing claim edits, denials, appeals and Chargemaster
• Serves as resource to the physicians and hospital staff.
• Reviews and investigates practice patterns and utilization trends and will report to Hospital Administration and/or Medical Staff on both routine and issue basis.
• Serves as liaison between accounts, patients, nursing, and physicians to appeal denied claims
• Assists as with the Medical Staff Outcomes and PI Coordinator clinical, statistical and performance improvement knowledge to support medical staff committees and clinical services in quality assessment activities impacting reimbursement.

Job Qualifications:

• Minimum of three (3) years’ experience in denials/appeals or experience in billing/chargemaster and knowledge of federal, state and private agency review requirements and regulations
• Knowledge of and the ability to apply relevant state and federal laws, statutes and regulations.
• Excellent communication skills (oral and written) with the ability to deal with providers, physicians and staff tactfully and effectively.
• Good organizational skills including the ability to set priorities. Self-directed/motivated.

Job Duties and Responsibilities:

Includes but is not limited to:

• Serves as resource to physicians and hospital staff.
• Ensures adherence to organization, professional, state and Federal regulations, guidelines, standards and policies/procedures relative to billing.
• Instructs and supports physicians, physician extenders, and staff of hospital departments with issues relative to State and Federal laws, regulations, guidelines, standards and policies/ procedures. Hospital departments may include but are not limited to Admissions (Grand Central), Patient Accounts and Medical Records
• Maintains effective communication with physicians, physician extenders and physician offices as well as KHH staff relative to assigned responsibilities
• Works with patient accounts team, coding team and the CFO using Optum to ensure the KHH chargemaster is accurate and updated according the State and Federal laws, regulations and guidelines
• Works with patient accounts and coding teams using the Optum when claims hit edits to ensure claims filed meet State and Federal laws, regulations and guidelines
• Works as part of a team to ensure completion of tasks in all areas
• Assists with Corporate Compliance Program and Compliance review activities in preparation for government reviews
• Other duties as assigned.