Revenue Integrity Analyst

Remote Jobs; Fort Myers (FL); On-site; USD 31,000 - 41,000; Full time

Job summary

Talentify in Fort Myers, FL is seeking a healthcare billing specialist to resolve billing issues and optimize reimbursements across multiple payers. You will use Craneware Online and EPIC WQ workflows to ensure proper bundling/unbundling of charges and applicable modifiers, aiming for maximal reimbursement while complying with billing rules.

Collaborating with BO, HIM and ADT teams, you will communicate results in daily interactions and monthly meetings, staying current on payer bulletins and

Qualifications

• Bachelor degree or higher preferred; 2 years post-high school in clinical, financial, or coding program.
• Minimum 3 years in healthcare, hospital billing, coding, or related reimbursement roles.
• Experience with third-party payer billing and CPT/HCPCS coding.
• Knowledge of APC and reimbursement regulations.
• Preferred coding certification.

Responsibilities

• Resolve billing issues and optimize reimbursement.
• Use Craneware Online and EPIC WQ workflows.
• Ensure correct bundling/unbundling of charges and modifiers.
• Communicate with BO, HIM and ADT to resolve payer disputes.
• Keep current on payer bulletins and APC payment changes.

Skills

Healthcare billing

Coding knowledge

Attention to detail

Education

Bachelor degree or higher preferred

2 years post high school in clinical/financial/coding

Tools

Craneware Online

EPIC WQ workflows

Job description

Location

Remote - Florida

US:FL:Fort Myers

Department

Department of Revenue Integrity

Work Type

Full Time

Shift

Shift 1/7:00:00 AM to 3:30:00 AM

Minimum to Midpoint Pay Rate

$22.78 - $29.62 / hour

Summary

Resolves billing issues, and provides coverage guidelines for billable services to reduce or prevent future claim denials. Employs Craneware Online, EPIC WQ workflows, and other accredited resources for assigned cost center(s) to identify potential reimbursement opportunities in a proactive manner. Ensures the appropriate bundling or unbundling of charges, and applicable modifiers applied so that all charges that are submitted result in optimal reimbursement while following applicable billing, coding and reimbursement regulations within respective areas. Interacts with other departmental staff, i.e. BO, HIM and ADT for resolution of third party payer billing disputes. Additionally, resolves CCI edits as appropriate, reviews Medicare intermediary and other third party payer bulletins to keep current on billing requirements and APC payment status and changes. Communicates relevant information to all applicable department personnel. Communicates results through daily interaction and monthly status meeting to the department team. Provides other support as needed.

Requirements

• Educational Requirements
• Degree/Diploma ObtainedProgram of StudyRequired/
• Preferredand/orHigh School Diploma or EquivalentRequiredAdditional Requirements
• Prefer Bachelor Degree or higher formal education, 2 years formal education post high school in clinical, financial, or coding program.Experience Requirements
• Minimum Years RequiredArea of ExperienceRequired/
• Preferredand/or3 YearsHealthcareRequiredAdditional Requirements
• 3 experience in healthcare-related field, in hospital billing, coding and/or charging/reimbursement-related capacity. Additional clinical experience in related field a plus.State of Florida Licensure Requirements
• LicensesRequired/
• Preferredand/orNot RequiredCertifications/Registration Requirements
• Certificates/RegistrationsRequired/
• Preferredand/orAdditional Requirements
• Coding certification preferred to include CPT, HCPCS, ICD9-10, and DRG