Hospital Revenue Integrity Specialist

Oklahoma Heart Hospital; Oklahoma City (OK); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and vision coverage

401(k) plan with employer match

Employee Assistance Programs (EAP)

Job summary

Oklahoma Heart Hospital is seeking a Hospital Revenue Integrity Specialist to evaluate and ensure accurate charges for hospital claims. The role involves reviewing clinical documentation, validating claims data, and collaborating with clinical leadership to prevent revenue loss.

The ideal candidate should have at least two years of experience in revenue integrity or coding, with knowledge of CPT/HCPCS and ICD-10 coding. Join us in shaping the future of heart care!

Qualifications

• Minimum of two years in Revenue Integrity, coding, charge entry, or billing.
• Knowledge of CPT/HCPCS and ICD-10 coding.
• Experience in cardiology is a plus.

Responsibilities

• Evaluate charges for hospital claims against clinical documentation.
• Review all system and clearing house edits for charges.
• Utilize EMR and clearinghouse to manage claim edits.
• Validate claims data against payer rules and regulations.
• Assist physicians in placing the correct procedure code.
• Recommend system optimization to capture incorrect charges.

Skills

Revenue Integrity

CPT/HCPCS coding

ICD-10 coding

Collaboration

Attention to detail

Education

High school diploma or equivalent

Job description

Overview

Join Our Team at Oklahoma Heart Hospital (OHH)

ONE TEAM. ALL HEART. At OHH, we believe that patient care is truly at the heart of everything we do. Our dedicated team members are involved in every step of our patients' journeys, bringing hope, compassion, and healing to both patients and their families. Together with our physicians and caregivers, we are shaping the future of heart care in Oklahoma by serving the state and leading the nation.

Benefits

Why You’ll Love Working Here:

• Comprehensive Benefits:
  • Medical, Dental, and Vision coverage
  • 401(k) plan with employer match
  • Long‑term and short‑term disability
  • Employee Assistance Programs (EAP)
  • Paid Time Off (PTO)
  • Extended Medical Benefits (EMB)
  • Opportunities for continuing education and professional growth

Responsibilities

The Hospital Revenue Integrity Specialist is responsible for evaluating charges for hospital claims against clinical documentation to identify missing, incorrect, or late charges. They evaluate charge capture processes to comply with government and non‑government rules and regulations, work pre‑bill edits related to clinical documentation (including CCI edits, MUEs, and billing edits), facilitate a charge reconciliation program with clinical leadership, and provide communication on missing or incorrect charges, making recommendations on best practices.

• 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 and 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.

As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care. Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care.