Revenue Integrity Specialist-Clinical

The Revenue Integrity Specialist-Clinical will perform internal quality assessment claim reviews to ensure compliance with federal, payer and internal Revenue Cycle policies. The position works in coordination with all hospital departments to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices across departments. Will respond to requests to research and provide resolution for claim data variances, evaluate payer updates and assist in the performance of chart-to-bill audits to produce and maintain timely, accurate, compliant and inclusive charge capture, coding and billing functions. Works to identify medical necessity and regulatory requirements related to charge integrity and recommend solutions., Provides service to internal hospital departments, both clinical and non-clinical and external customers such as UNC Health Care and affiliated system entities, managed care organizations, third party payers and patients by providing quality service, communication and assistance. Performs duties in a manner that projects a positive image of the department and hospital. LENOIR

Graduate from an accredited school of nursing.

PROFESSIONAL EXPERIENCE REQUIREMENT Minimum of 2 - 4 years of experience in a clinical setting preferred. Experience in Utilization Management, medical audit/review and appeals/denials experience preferred. Knowledge and understanding of CPT/HCPCS coding requirements, third party payer billing and reporting requirements preferred.

LICENSURE/REGISTRATION/CERTIFICATION North Carolina Registered Nurse License

KNOWLEDGE, SKILLS, AND ABILITIES REQUIREMENTS Strong verbal, written and interpersonal communication skills. Skills with Microsoft applications including Excel. Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations. Knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Strong analytical and problem-solving skills. Strong understanding of various reimbursement methodologies. Comfortable presenting to and interacting with senior levels of hospital leadership.

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