Revenue Integrity & Denials Optimization Specialist

WVU Medicine; Charleston (WV); On-site; USD 65,000 - 90,000; Full time

Job summary

SYSTEM West Virginia University Health System in Charleston, WV is seeking a Billing Analyst to review charge edits and ensure compliance with CCI, OCE, MUE, LCD and NCD policies while maximizing reimbursement.

The role collaborates with Revenue Cycle leadership to develop, test, implement, and optimize the Revenue Guardian module and related tools, communicating training needs to clinical leadership and the chargemaster committee.

Qualifications

• Experience with payor edits and compliant billing.
• Knowledge of LCD/NCD policies.
• Ability to analyze denials and appeals.
• Experience with root-cause analysis and corrective actions.

Responsibilities

• Manages payor and claim edits in a timely, accurate and compliant manner.
• Tracks edited accounts and outcomes; coordinates follow-up for edits.
• Monitors denials, appeals, and follow-up activities related to edits.
• Assists departments with government regulation compliance related to edits.
• Collaborates to ensure optimal charge capture for services.
• Maintains knowledge of payer policies and regulatory changes.

Skills

Computers

Medical terms

ICD-10 codes

CPT/HCPCS codes

Analytical thinking

Communication skills

Microsoft Excel

Reporting tools

Payor policies

Regulatory knowledge

Education

High School Diploma

Bachelor's degree in business or healthcare

Health Information Technology graduate

Tools

Epic Revenue Guardian

Billing software

Job description

SYSTEM West Virginia University Health System in Charleston, WV is seeking a Billing Analyst to review charge edits and ensure compliance with CCI, OCE, MUE, LCD and NCD policies while maximizing reimbursement.

The role collaborates with Revenue Cycle leadership to develop, test, implement, and optimize the Revenue Guardian module and related tools, communicating training needs to clinical leadership and the chargemaster committee.