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Revenue Integrity Analyst

Company: Lee Health
Location: Fort Myers
Posted on: June 12, 2019

Job Description:

Resolves billing issues, and provides coverage guidelines for billable services to reduce or prevent future claim denials. Employs Craneware Online, EPIC WQ workflows, and other accredited resources for assigned cost center(s) to identify potential reimbursement opportunities in a proactive manner. Ensures the appropriate bundling or unbundling of charges, and applicable modifiers applied so that all charges that are submitted result in optimal reimbursement while following applicable billing, coding and reimbursement regulations within respective areas. Interacts with other departmental staff, i.e. BO, HIM and ADT for resolution of third party payer billing disputes. Additionally, resolves CCI edits as appropriate, reviews Medicare intermediary and other third party payer bulletins to keep current on billing requirements and APC payment status and changes. Communicates relevant information to all applicable department personnel. Communicates results through daily interaction and monthly status meeting to the department team. Provides other support as needed.


Educational RequirementsDegree/Diploma ObtainedProgram of StudyRequired/

Preferredand/orHigh School Diploma or EquivalentRequiredAdditional RequirementsPrefer Bachelor Degree or higher formal education, 2 years formal education post high school in clinical, financial, or coding program.Experience RequirementsMinimum Years RequiredArea of ExperienceRequired/

Preferredand/or3 YearsHealthcareRequiredAdditional Requirements3 experience in healthcare-related field, in hospital billing, coding and/or charging/reimbursement-related capacity. Additional clinical experience in related field a plus.State of Florida Licensure RequirementsLicensesRequired/

Preferredand/orNot RequiredCertifications/Registration RequirementsCertificates/RegistrationsRequired/

Preferredand/orAdditional RequirementsCoding certification preferred to include CPT, HCPCS, ICD9-10, and DRG

Keywords: Lee Health, Fort Myers , Revenue Integrity Analyst, Professions , Fort Myers, Florida

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