Business Integrity Analyst Credentialed

HCA Healthcare is part of the nation's leading provider of healthcare services, and they are seeking a Business Integrity Analyst Credentialed. This role involves determining the appropriateness of patient charges and managing billing integrity through analysis and resolution of billing edits while ensuring compliance with regulatory requirements.

Responsibilities:

• Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. 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 and condition codes, as appropriate
• Identify charging, chargemaster coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues that are identified while working on edits
• Serve as charge master liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary
• Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Billing Integrity procedures and implement changes as needed
• Maintain billing education, attend webcasts and conference calls as required

Requirements:

• Associate degree or above; or healthcare license/certification required
• Minimum 1 year directly related Healthcare experience or coding experience required
• Healthcare certification/licensure such as RHIT, CCS, CCP, CPC or other recognized AHIMA certified coding credential, LPN, LVN, RT, PT, etc., can be accepted lieu of degree with work experience
• Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews preferred