Revenue Integrity Specialist II (Full Time)

Job Summary:
Reviews and manages outpatient medical necessity compliance including assisting Registration staff with obtaining appropriate documentation, reviewing medical necessity denials, obtaining supporting documentation, submitting appropriate appeals, researching policies of CMS and/or Medicare Administrative Contractor, reviewing documentation prior to release for audit and maintaining compliance software. Provides education to providers and staff related to medical necessity compliance. Accurately codes diagnoses and procedures for assigned coding responsibility utilizing appropriate coding classification systems. Provides back-up support to the Revenue Integrity Supervisor and Revenue Integrity Specialist I.

Location:
Alexander City, AL

Hours:
Full Time with Benefits
Monday-Friday 8:00am-4:30pm

Minimum Qualifications:
Education: Registered Nurse or Licensed Practical Nurse; or Registered Health Information Technician; or another comparable health care field registration or licensure.

Experience: Five (5) years experience minimum in nursing or five (5) years experience in utilization review, case management, physician office practice, DRG Management / ICD-10-CM /CPT-4® coding.

Licenses, Certifications, and/or Registrations: Current Alabama nursing license or current registration with the American Health Information Management Association as RHIA, RHIT or CDIS.

Equipment/Tools/Work Aids: Personal computer terminal with encoder, compliance, online reference toolkit, Experian compliance checker and Microsoft Office software.

Specialized Knowledge and Skills: Must be dependable and self motivated with pleasant, personable manner. Must be capable of communicating effectively with physicians, non-physician providers, hospital staff and physicians’ office staff efficiently and effectively. Must be flexible, able to motivate others and organize workload. Must be able to develop rapport with medical staff and hospital staff in all departments and maintain a professional attitude at all times. Must have the ability to complete work thoroughly and accurately with efficiency and effectiveness. Must have legible penmanship.

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