UNC Health
Revenue Integrity Analyst - HIM Revenue Integrity
UNC Health, Chapel Hill, North Carolina, United States, 27517
Revenue Integrity Analyst - HIM Revenue Integrity
Join UNC Health as a Revenue Integrity Analyst in the HIM Revenue Integrity team. UNC Health is a large, inclusive organization dedicated to improving the health and well‑being of the communities we serve.
Summary The Revenue Integrity Analyst researches and resolves complex carrier/payor claim edits, including Correct Coding Initiative (CCI) and Medically Unlikely Edits (MUE), as well as complex payor denials and audits. The role assists with appealing coding denials, collaborates on charging and coding issues, and ensures claims are compliant with payer specifications prior to submission.
Responsibilities
Research and resolve complex carrier/payor claim edits, including CCI and MUE.
Possess claims coding, reimbursement, and billing skills to review and analyze charges and coding for compliance.
Develop a full understanding of application systems and their use in charging, billing, order entry, and the financial process of UNC Health System.
Audit the accuracy of charges based on third‑party audit requests and document findings in the internal audit system.
Review observation cases to accurately capture observation hours and infusion charges.
Collaborate with departments on charging and coding issues.
Research, resolve, and initiate the Medicare Part A/Part B process.
Identify and troubleshoot charge issues and opportunities for charge/process enhancements.
Research, resolve, educate, and act as a liaison with Patient Financial Services, Health Information Management, and hospital‑based clinical departments regarding the CCI edits that suspend claims software.
Ensure that only appropriate codes are grouped.
Qualifications
Education 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).
Licensure/Certification Requirements
– No licensure or certification required.
Professional Experience Requirements
If a Bachelor’s degree: Three (3) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.
If an Associate’s degree: Seven (7) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.
If a high school diploma or GED: Eleven (11) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.
Knowledge/Skills and Abilities Requirements
Ability to research complex coding and regulatory requirements to understand and analyze payer regulations and coding guidelines.
Extensive knowledge of CCI edits, CPT, HCPCS, ICD, revenue codes, modifiers, billing, and regulations for Medicare, Medicaid and third‑party billing.
Results‑oriented with strong deadline management in a fast‑paced, dynamic, project‑oriented environment.
Self‑motivated, detail‑oriented with strong analytical and critical‑thinking skills.
Effective verbal and written communication skills and ability to professionally present information to all levels of management.
Understanding of overall hospital revenue cycle functions.
Job Details Legal Employer: NCHEALTH Entity: Shared Services Organization Unit: HIM Revenue Integrity Work Type: Full Time Standard Hours Per Week: 40 Salary Range: $24.73 – $35.56 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Remote Work Schedule: Day Job Location of Job: US: NC: Chapel Hill Exempt From Overtime: Exempt: Yes
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants’ and employees’ religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email
applicant.accommodations@unchealth.unc.edu
if you need a reasonable accommodation to search and/or apply for a career opportunity.
#J-18808-Ljbffr
Summary The Revenue Integrity Analyst researches and resolves complex carrier/payor claim edits, including Correct Coding Initiative (CCI) and Medically Unlikely Edits (MUE), as well as complex payor denials and audits. The role assists with appealing coding denials, collaborates on charging and coding issues, and ensures claims are compliant with payer specifications prior to submission.
Responsibilities
Research and resolve complex carrier/payor claim edits, including CCI and MUE.
Possess claims coding, reimbursement, and billing skills to review and analyze charges and coding for compliance.
Develop a full understanding of application systems and their use in charging, billing, order entry, and the financial process of UNC Health System.
Audit the accuracy of charges based on third‑party audit requests and document findings in the internal audit system.
Review observation cases to accurately capture observation hours and infusion charges.
Collaborate with departments on charging and coding issues.
Research, resolve, and initiate the Medicare Part A/Part B process.
Identify and troubleshoot charge issues and opportunities for charge/process enhancements.
Research, resolve, educate, and act as a liaison with Patient Financial Services, Health Information Management, and hospital‑based clinical departments regarding the CCI edits that suspend claims software.
Ensure that only appropriate codes are grouped.
Qualifications
Education 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).
Licensure/Certification Requirements
– No licensure or certification required.
Professional Experience Requirements
If a Bachelor’s degree: Three (3) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.
If an Associate’s degree: Seven (7) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.
If a high school diploma or GED: Eleven (11) years of acute healthcare experience with emphasis on APC/OPPS/IPPS coding, billing, auditing, compliance and/or charge master issues.
Knowledge/Skills and Abilities Requirements
Ability to research complex coding and regulatory requirements to understand and analyze payer regulations and coding guidelines.
Extensive knowledge of CCI edits, CPT, HCPCS, ICD, revenue codes, modifiers, billing, and regulations for Medicare, Medicaid and third‑party billing.
Results‑oriented with strong deadline management in a fast‑paced, dynamic, project‑oriented environment.
Self‑motivated, detail‑oriented with strong analytical and critical‑thinking skills.
Effective verbal and written communication skills and ability to professionally present information to all levels of management.
Understanding of overall hospital revenue cycle functions.
Job Details Legal Employer: NCHEALTH Entity: Shared Services Organization Unit: HIM Revenue Integrity Work Type: Full Time Standard Hours Per Week: 40 Salary Range: $24.73 – $35.56 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Remote Work Schedule: Day Job Location of Job: US: NC: Chapel Hill Exempt From Overtime: Exempt: Yes
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants’ and employees’ religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email
applicant.accommodations@unchealth.unc.edu
if you need a reasonable accommodation to search and/or apply for a career opportunity.
#J-18808-Ljbffr