Revenue Integrity Coordinator

Westchester Medical Center; Town of Mount Pleasant (NY); On-site; USD 65,000 - 85,000; Full time

Job summary

Westchester Medical Center is seeking a Revenue Integrity Coordinator to review and revise accounts for enhanced revenue and compliant billing. The role focuses on accurate charge capture, timely billing, and educational follow-up on coding questions.

Key responsibilities include monitoring queues, researching coding errors, and promoting best practices to withstand audits across Cerner, SSI, and other EMRs. Travel to WMCHealth facilities may be required.

Qualifications

• Minimum two years clinical experience in a healthcare setting.
• Experience with Excel preferred.
• Electronic Medical Records experience preferred.

Responsibilities

• Monitor work queues to identify pending charges and resolve issues.
• Research coding errors and provide feedback to providers.
• Recommend billing/coding best practices to withstand audits.
• Educate departments and analyze trends to improve revenue cycle processes.
• Identify pre-bill and post-bill edits related to services and modifiers.
• Work with Cerner, SSI, and other EMRs to correct billing issues.
• Review codes and collaborate with patient billing on bundling/unbundling per CMS/CCI.
• Research CPT/HCPCS CMS guidance to resolve issues and ensure compliance.
• Maintain audit status information and report issues.
• Participate in regulatory changes and with special projects.

Skills

Clinical experience

Excel

EMR experience

Education

High School Diploma

Associate degree preferred

Tools

Cerner

SSI

Patient Keeper

Paragon

Job description

Job Summary:

The Revenue Integrity Coordinator reviews and revises accounts to achieve revenue enhancement and billing/coding compliance. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing. The incumbent identifies patterns for educational opportunity, researches coding questions, and tracks audited cases.

Responsibilities:

• Monitors various work queues and reports to identify pending charges and works to resolve issues.
• Researches coding errors to identify resolutions. Provides feedback to providers to correct errors.
• Recommend sound billing/coding best practices that are able to withstand audits.
• Foster continuous improvement of revenue cycle processes through education with various departments and trend analysis.
• Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered.
• Works within Cerner and within SSI to correct billing issues.
• Works with additional EMRs (Patient Keeper, Paragon) to review billing/coding.
• Performs periodic review of codes and works with patient billing regarding bundling and unbundling services as delineated in CMS and CCI edits.
• Researches technical guidance in CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance.
• Maintains and provides information on status of audits and issues presented.
• Works on special projects as required.
• Participates in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
• Performs other duties as assigned.

Qualifications/Requirements:

Experience:

Minimum two years clinical experience in a healthcare setting, Preferred experience in Excel and Electronic Medical Records experience.

Education:

High School Diploma required. Associate’s Degree preferred or two years’ work experience.

Licenses / Certifications:

Certified Professional Coder (CPC) or similar credential, preferred.

Other:

Familiarity with medical record documentation standards and practices, health care insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and ICD-10-CM codes is preferred. Special Requirements: Requires travel to other WMCHealth Facilities.