Revenue Integrity Analyst: Denials & Claims Optimization

University of Toledo Physicians; Toledo (OH); Hybrid; USD 70.000 - 90.000; Vollzeit

Benefits dieser Stelle

403B plan

Zusammenfassung

University of Toledo Physicians seeks a Revenue Integrity Specialist (Hybrid) to manage clinical denial analysis and ensure accurate claim submissions. The role, within Revenue Cycle, collaborates with coding and billing to reduce denials and improve processes.

Qualified candidates will maintain knowledge of payer policies and coding accuracy. The position requires a CPC/CPC-H/CCS-P/RHIT/CCA certification or willingness to obtain within 12 months, strong communication, and extensive EPIC

Qualifikationen

• High-school diploma or equivalent.
• Current certification from an accredited coding association (CPC, CPC-H, CCS-P, RHIT, CCA, etc.) or willingness to obtain within twelve (12) months of hire.
• Demonstrated ability to work independently.
• Excellent communication and interpersonal skills.
• Strong organizational and task management skills.
• Strong critical thinking and analytical skills.
• Proficient in Microsoft Office products.
• Ability to navigate shifting workflows and priorities.
• Ability to work collaboratively in a team-oriented environment, courteous and friendly demeanor.
• Ability to exercise sound judgment and problem-solving skills.
• Ability to handle patient and organizational information in a confidential manner.

Aufgaben

• Identify denial patterns and elevate to management as appropriate.
• Make recommendations for additions/ revisions to work queues, claim edits and potentially workflows to improve efficiency and reduce denials.
• Review payer communications and policies to identify potential changes or concerns related to coding initiatives; elevate potential issues to appropriate parties.
• Identify opportunities for coding and documentation process improvement and actively participate in completing these initiatives.
• Identify root cause of denials.
• Reviews denied claims to ensure coding was appropriate, make corrections and resubmit when/as needed.
• Provides regular feedback to team members and coding/physician educators.
• Assists and collaborates with coding and billing manager to identify and rectify coding concerns.
• Responsible for reviewing effectiveness of coding related pre-bill edits to ensure claims are clean and error free.
• Will maintain current knowledge of regulations and payer policies, including LCDs.
• Will maintain current coding certification.
• All other duties as assigned.

Kenntnisse

Independent work

Excellent communication

Organizational skills

Critical thinking

Microsoft Office

Adaptability to changing workflows

Team collaboration

Judgment

Confidentiality

Ausbildung

High-school diploma or equivalent

CODING/REVENUE CYCLE CERTIFICATION (CPC/CPC-H/CCS-P/RHIT/CCA) or within 12 months

Tools

EPIC

Jobbeschreibung

University of Toledo Physicians seeks a Revenue Integrity Specialist (Hybrid) to manage clinical denial analysis and ensure accurate claim submissions. The role, within Revenue Cycle, collaborates with coding and billing to reduce denials and improve processes.

Qualified candidates will maintain knowledge of payer policies and coding accuracy. The position requires a CPC/CPC-H/CCS-P/RHIT/CCA certification or willingness to obtain within 12 months, strong communication, and extensive EPIC