The Revenue Integrity Coordinator will work designated accounts to resolve claim edits prior to billing by analyzing medical record documentation and application of CMS guidance. This position will evaluate and provide guidance related to billing or clearinghouse system edits. This position will also provide guidance and education to care site departments related to charging, coding, modifiers, value codes, and required medical record documentation to support accurate billing. It will also assist with internal audit analysis identified by Audit and Reimbursement.
· Analyze and resolve specific billing edits delaying claims from processing within Epic and/or clearinghouse systems which require clinical knowledge and/or coding expertise. This includes the verification and/or correction of billing data for accuracy and completeness following regulatory requirements, care site protocols, SCL Health standard, and supported by medical record documentation. Resolution may include charge correction or the application of modifiers, value codes and condition codes, as appropriate.
· Provide analysis and guidance for system changes that are not aligned properly between the organizations operating systems and the billing software utilized by SCL Health.
· Evaluate system edit logic and provide guidance on enhancements to either begin holding claims for compliance review or remove logic so claims are released without holding.
· Identify charging, coding, or clinical documentation issues and work with appropriate leadership, ancillary departments, Revenue Service Center, care sites, Charge Master and/or system services to resolve.
· Perform compliance charge audits by verifying billing data as compared to documentation and making corrections within Epic as needed. Recommend process improvements to care site ancillary department directors in order to improve documentation, charging flow, and accuracy.