• Revenue Integrity Specialist

    Job ID
    2018-21678
    Employment Type
    full-time
    Hours Per Week
    40.00
    Onsite Work Schedule Details
    M-F 8-5
    Address
    527 W. South Street
    City
    Woodstock
    State
    IL
  • Overview

    The Revenue Specialist is responsible for performing pre-bill concurrent audits on all coding colleagues and/or physicians for Pro-fee coding at specific strategic sourcing site(s), as assigned, on a monthly or quarterly basis as designed.  Medical records previously coded by coding colleagues or Physicians who code of services are reviewed to assure accuracy of coding.  Audit results are shared with coding colleagues and/or Physicians and education provided as necessary.  In addition, the Revenue Integrity Specialist is responsible for reviewing all external coding audits performed by third party payors or Recovery Auditor Contractors and responding to external audit findings.

    Responsibilities

    • Performs inpatient, ambulatory surgery, emergency department, outpatient services, Pro-Fee and evaluation and management pre-bill concurrent coding audits.
    • Reviews inpatient records to assure accurate MS-DRG or APR-DRG assignment by coding colleagues and Patient Safety Initiatives or quality measures are identified.
    • Reviews outpatient records to assure accurate CPT/HCPCS, E&M Code and modifier assignment as well as accurate APC assignment.
    • Determines appropriate audit sample size per colleague based on volume to assure statistical significance.
    • Reviews abstracted data by coding colleagues to assure data accuracy specific to the client’s requirements.
    • Communicates both internal and external audit results and provides education to coding colleagues or Physicians as required. In addition, provides summary audit results to the Revenue Integrity Manager, Sr. Director, Coding Shared Services, DHIM and Director of Strategic Source managing each account
    • Collaborates with Clinical Documentation Improvement lead (if applicable) to identify opportunities for training and education with coding colleagues.
    • Reviews all third party payor external coding audit results.
    • Reviews, researches and prepares response(s) to all third party payor external coding denials within the time frame required by the third party payor.
    • Responsible for assuring all required coding and data corrections from any retrospective review findings are completed and submitted to the Patient Accounts Department as required by the facility.
    • Maintains coding accuracy statistics for each coding colleague or Physician and each client site
    • MaintainsICD-10-CM, ICD-10-PCS, CPT/HCPCS and DRG accuracy rate of at least 95%.
    • Keeps current with all CPT/HCPCS and ICD-10 coding principles, requirements and coding reference guidelines as well as Hospital Acquired Condition diagnoses, Patient Safety Initiatives as well as Office of Inspector General’s worklist
    • Maintains strict physician and patient confidentiality
    • Supports nThrive’s Compliance Program by demonstrating adherence to all compliance policies and procedures as evidenced by in-service attendance and daily practice; notifying management when there is a compliance concern or incident; demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information; promoting confidentiality and using discretion when handling patient information.
    • Reviews materials, completes all required client/nThrive policy training documents and passes required tests.
    • Participates in nThrive Town Hall meetings.
    • Performs other related duties as assigned or requested.

    Qualifications

    • RHIA or RHIT required plus CCS and CCS-P or CPC
    • Knowledge of medical terminology, anatomy and physiology, laboratory test and results, disease processes and pharmaceuticals required.
    • Thorough understanding of hospital billing, chart reviews and coding, payer contracts and reimbursement rates, as well as other revenue cycle functions.
    • Knowledge of LCD (Local Code Determinations, NCD (National Code Determinations), CCI (Correct Coding Initiatives), and OCE (Outpatient Code Editor).
    • Proficiency with hospital computer systems, Encoders and Computer Assisted Coding Software
    • Proficiency in using MS Word, Excel and PowerPoint applications as well as proficiency using web based communication applications such as SKYPE and ZOOM.
    • Minimum of ten (10) years coding and auditing experience in an acute care facility.
    • Knowledge and proficient in the application of ICD-10-CM, ICD-10-PCS and HCPCS/CPT code assignment.

    About nThrive

    Be Inspired. Ignite Change. Transform Health Care. 

    From Patient-to-PaymentSM, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.

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