Description

Job Schedule:
Standard Hours: 40
Job Shift: Shift 1
Shift Details: Remote job

Work where every moment matters.

Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Department Description:

The Revenue Integrity (RI) department requires highly skilled technical staff that has certified coders to correct and resolve claim and denial issues. In addition, the department includes a team of Revenue Integrity Analysts and Charge Description Master (CDM) analysts. We serve as liaisons between Clinicians, other Revenue Cycle departments and Information Technology. Our objective is to assure a clean claim is produced. Our teams are located, on-site or remotely. Our primary location is the Central Business Office in Newington.

Position Summary:

The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim.

Position Responsibilities:

• Analyze and resolve specific billing edits and denials that require coding and billing expertise with some clinical knowledge that are delaying claims from processing in the Patient Accounting system; This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers, diagnosis codes as appropriate including charge corrections
• Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary, Patient Financial Services, HIM, departments, etc. regarding charging and clinical documentation issues.
• Participate as a member of the Revenue Integrity work group and report charging and medical necessity issues as appropriate.

Reports To: Supervisor, Revenue Integrity Specialist

Qualifications

Education: High School diploma or GED required.Undergraduate degree preferred.

Experience: Healthcare experience required. Clinical experience preferred

Licensure, Certification, Registration: CCS, CCS-P, CP, RHIT, RHIA is required. Licensed RN preferred

Knowledge, Skills and Ability Requirements:

• Excellent communication skills both verbal and written
• Good interpersonal skills
• Able to establish good customer relationships with trust and respect
• Able to travel as needed
• Computer skills: navigation and edit resolution through various Web based systems. Ability to use email, Excel, Word

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.