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Revenue Integrity Specialist I

2 months ago

Maryland Heights, United States Ranken Jordan Pediatric Bridge Hospital Full time
Job DescriptionJob Description

Ranken Jordan is the country's first pediatric bridge hospital. Inpatients and outpatients with complex medical conditions, injuries and illnesses come to our one-of-a-kind facility from throughout the region to get better faster and prepare for the transition back to home.


A Peek Behind the Room Divider:

  • Founded in 1941 by Mary Ranken Jordan who implored her staff to "...consider the children, first, in all that we do." These words still guide every employee, every day.
  • Our guiding mission is to help kids and their families' transition from hospital to home. That means we practice world-class pediatric medicine to treat the symptoms but we also train parents and caregivers to provide a high-level of care at home so patients continue to progress after discharge
  • "Care Beyond the Bedside" means that our kids receive their therapies and rehab away from their rooms and out of their beds as much as 70% of the day. The rest of the time, they are playing just being kids in our state of the art facility designed to inspire children

JOB SUMMARY:

The revenue cycle specialist is responsible for overseeing and assisting with inpatient and outpatient billing, including professional fees. Interacts with families/responsible parties for questions related to the billing or reimbursement process. Responsible for up-front and previous balance collections as needed and performing job duties in accordance with the policies and mission of Ranken Jordan Pediatric Bridge Hospital.


DUTIES AND RESPONSIBILITIES:

  • Assist in managing primary and secondary billings for Outpatient, and Physician Fees. Ensure that both electronic and hard copy claims are sent in a timely, accurate and efficient manner to the appropriate insurance payor.
  • Assist with review of any credit balances on patient's account that are over 30 days. Request refunds as needed, ensuring information is posted to the proper patient's accounts in a timely and accurate manner.
  • Determine patient's financial responsibilities as indicated by insurance and accurately document findings in the EMR. Contact patients prior to date of service to discuss financial obligations and to collect any monies owed, including co-pays, deductibles, co-insurance, and any past-due balances prior to date of service. Discuss questions and concerns over charges, payments posted, and any insurance questions. Refer patients and families to financial services as needed for financial assistance.
  • Assist in reviewing insurance remits from various websites and received via mail or fax and compare actual reimbursement to expected reimbursement based on services billed. Participate in monthly/quarterly calls with provider representatives to discuss variances identified and paths needed and/or taken for resolution.
  • Assist coordination with team members and other departments as needed to conduct follow-ups on all unpaid claims that have been billed and remain unpaid 30 days after initial billing. Any reason for non-payment should be documented within the patient record in Cerner and if appropriate, placed on the tracking tool.

QUALIFICATIONS:

  • At least 2 years' insurance experience in a medical or hospital business office setting required.
  • Knowledge of ICD-10, Revenue Codes, HCPCS/CPT Codes and Medicaid strongly preferred.
  • Knowledge of payor contracts, reimbursement methodologies, electronic remittances and payment posting preferred.
  • Excellent organizational, time management, and critical thinking skills required.
  • Ability to prioritize multiple tasks and work independently required.
  • Experience working in Cerner preferred.
  • Computer skills including but not limited to Microsoft Office, Excel, and Word required
PHYSICAL DEMANDS:

These include stooping, kneeling, crouching, reaching, grasping, pulling, pushing, standing, carrying, and lifting of light loads (up to 35 lb.), as necessary.



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