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Revenue Integrity Clinical Reviewer

Company: The Queens Health Systems
Location: Honolulu
Posted on: August 6, 2022

Job Description:

ResponsibilitiesI. JOB SUMMARY/RESPONSIBILITIES:--- - Provides support for timely, accurate and inclusive charge capture coding and billing functions through the evaluation of payer updates, performance of record audits, educational presentations to staff and other related activities.--- - Works collaboratively with clinical operations staff to identify and remediate issues regarding the timeliness and/or accuracy of charges.--- - Manages assigned functions to improve hospital revenue by decreasing expenses and preventing external charge audits by ensuring accurate and appropriate charge and revenue capture.II. TYPICAL PHYSICAL DEMANDS:--- - Essential: finger dexterity, seeing, hearing, speaking. ---- - Continuous: sitting, static gripping of an object for prolonged periods. ---- - Frequent: walking. ---- - Occasional: standing, stooping/bending, climbing stairs, walking on uneven ground, lifting and carrying usual weight of 1 pound up to 5 pounds, reaching above, at and below shoulder level, frequent gripping of an object.--- - Operates computer, calculator, telephone, fax and printer.III. TYPICAL WORKING CONDITIONS:--- - Not substantially subjected to adverse environmental conditions.IV. MINIMUM QUALIFICATIONS:A. - EDUCATION/CERTIFICATION AND LICENSURE:--- - Current Hawaii State license as a Registered Nurse.--- - Bachelor's degree in Nursing.--- - Certification in health information management, preferably RHIA or RHIT, preferred. - ---- - Certified Outpatient Coder (COC), Certified Professional Coder (CPC), and/or Certified Professional Coder-Payer (CPC-P) from AAPC, preferred.--- - Certified Coding Associate (CCA), Certified Coding Specialist (CCS), and/or Certified Coding Specialist-Physician Based (CCS-P) from AHIMA, preferred.B. - EXPERIENCE:--- - Two (2) years nursing experience in an acute care facility working with an electronic hospital information system. - EPIC preferred.--- - Prior leadership or supervisory experience.--- - Two (2) years experience in charge capture and charge audits, preferred.--- - Experience to demonstrate: - o - Ability to investigate, analyze and resolve issues at an organizational level. - o - Excellent communication, organizational and problem solving skills.--- - Prior experience using Microsoft Office applications (i.e. Outlook, Word, Excel).--- - Knowledge of medical coding, billing claim forms, and federal and state regulations related to rules/coverage, preferred.--- - Technical knowledge of coding principles of CPT/HCPCS and modifier selection as well as UB-04 revenue codes, preferred.Equal Employment OpportunityEqual Opportunity Employer / Disability / Vet#queens11

Keywords: The Queens Health Systems, Honolulu , Revenue Integrity Clinical Reviewer, Healthcare , Honolulu, Hawaii

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