Billing Integrity Analyst RN

About This Role

The Billing Integrity Analyst RN determines the appropriateness of patient charges and Charge Description Master (CDM) assigned HCPCS/CPTs by reviewing medical records and verifying billing data for accuracy and completeness. This role applies clinical expertise to resolve complex billing edits, ensures regulatory compliance, and serves as a liaison between facility administration, Shared Services, and ancillary departments regarding charging issues.

Responsibilities

• Analyze and resolve specific billing edits requiring RN's clinical expertise that delay claims processing in Patient Accounting and/or Relay Health systems.
• Verify and/or correct billing data for accuracy and completeness, following regulatory requirements and reviewing medical records, facility protocols, and other documentation.
• Apply modifiers and condition codes as appropriate to billing data.
• Identify charging, coding, or clinical documentation issues and collaborate with appropriate leadership and ancillary departments to resolve them.
• Perform charge audits by comparing billing data to documentation and making necessary corrections in Patient Accounting.
• Analyze charge review findings and provide recommendations to facility ancillary department directors to improve documentation, charging flow, and accuracy.
• Serve as a chargemaster liaison to facilitate clinical department education on appropriate charging of CPT codes and Revenue Codes.
• Perform assigned charge reviews (governmental, corporate, insurance defense, patient requested, collections, denials, focused review, SPAEs, cosmetics) by researching documentation and analyzing information.
• Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCDs), implementing changes to Billing Integrity procedures as needed.
• Participate in customer service events at the facility, such as FECC Committee meetings and new director onboarding, and report charging issues.

Requirements

• RN or other advanced nursing degree
• Active Registered Nurse License or other advanced nursing license
• Compact license for all states accepted

Qualifications

• RN or other advanced nursing degree required
• Healthcare experience in an acute care hospital or coding experience preferred.

Nice to Have

• Healthcare experience in an acute care hospital
• Coding experience
• Knowledge of CPT/HCPCS codes or experience in charging or performing charge reviews

Skills

* Required skills

Benefits