Revenue Integrity Coordinator - Claims
At Stony Brook Medicine the Revenue Integrity Coordinator- Claims
reviews diagnoses, and surgical procedures of cases identified through the claim scrubber, makes corrections in accordance with established coding and abstracting guidelines. Makes recommendations for changes and improvements to prevent future denial write- offs and improve cash acceleration.
The incumbent will work closely with the Associate Director of Revenue Integrity and will play a significant role in reviewing/reporting and correcting claims which fail the “bill scrubber” process, with the goal of improving the number of “clean claims” sent out for billing.Duties of a Revenue Integrity Coordinator - Claims may include the following but are not limited to:
Qualifications Required Qualifications:
- Review diagnoses, and surgical procedures of cases identified through the claim scrubber, make corrections in accordance with established coding and abstracting guidelines. Adhering to Medicare LCD / NCD, MUE and commercial payer guidelines
- Assist with implementation and maintenance of a mechanism for communication and resolving coding discrepancies.
- Provide feedback reports for trending and continuous identification of documentation and coding improvement opportunities
- Identify opportunities to improve revenue capture, reduce unnecessary processes, enhance billing compliance and accelerate cash flow
- Improve percentage of “clean claims” sent out to third party payers
- Other duties as assigned
- Bachelor's Degree with RHIA credential; OR Associates Degree in Health Information Technology or equivalent with RHIT credential; OR successful completion of a coding program with one of the following credentials: CCS or CCS-P or CPC
- Three years' experience in acute care hospital coding and auditing
- Strong knowledge of ICD-10 CM, HCPCS /CPT 4 coding and use of modifiers
- Familiarity with the NCCI Policy Manual and CCI edits
- Ability to research and understand Medicare LCD's and commercial payer coverage policies.
- Experience with Claims Scrubber Analysis
- Proficient in Microsoft Office applications, including Excel
- AHIMA or AAPC Certified: CCS or CCS-P or CPC
- Master's Degree or professional licensure.
- Experience working with hospital patient accounting systems.
Special Notes: Resume/CV and cover letter should be included with the online application. Posting Overview:
- Experience with acute hospital claims scrubber analysis and edit resolution.
- Experience with charge capture auditing and/or software.
- Knowledge of other governmental and third party payer reimbursement methodologies.
This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).
If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date. ___________________________________________________________________________________
Prior to start date, the selected candidate must meet the following requirements:
- Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
- All Hospital positions maybe subject to changes in pass days and shifts as necessary.
- This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
- This function/position maybe designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer. *The hiring department will be responsible for any fee incurred for examination. ___________________________________________________________________________________
- Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
- Complete electronic reference check with a minimum of three (3) professional references.
- Successfully complete a 5 panel drug screen*
- Successfully complete a Background Check investigation.
- Provide a copy of any required New York State license(s)/certificate(s).
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws. If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280. In accordance with the Title II Crime Awareness and Security Act
a copy of our crime statistics can be viewed here.
To apply, visit https://stonybrooku.taleo.net/careersection/2/jobdetail.ftl?job=2102443&tz=GMT-07%3A00&tzname=America%2FLos_Angeles
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