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Revenue Integrity Specialist I
3 months ago
Job Description:
Baptist Health is looking for a Revenue Integrity Specialist I to join our team. This is a remote position that requires residency in KY or IN
Research denials from all commercial and governmental payors, including pre-denial audits performed by UPICs or similar entities.
Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing.
Responds to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines.
Minimum Education, Training and Experience Required
- Bachelor's Degree in a related field, Practical Nurse License, or Coding Certification with at least two years healthcare experience. In lieu of bachelor's degree, five years of healthcare experience required with at least two of those in a revenue cycle related area such as registration, patient accounting, financial services, or managed care.
- Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal resolution processes; and managed care contracts. Individuals working with government audits must have a keen understanding of all audit response requirements and timelines.
Baptist Health is an Equal Employment Opportunity employer.