Revenue Integrity Coordinator

4 weeks ago

Chattanooga, United States Erlanger Health Full time

Job Summary:

The Revenue Integrity Coordinator is responsible for the tracking, analysis and trending of all audits in the Revenue Integrity program received into the Erlanger Health System. These include all Governmental Program Integrity Audits and other payer audit requests. The Revenue Integrity Coordinator will assist the Revenue Integrity Manager in the reporting of data to the Erlanger Executive Management Team, including the Erlanger Compliance Committee.

Education:

Required:

Bachelor's Degree in Healthcare or Finance Related area or Associate Degree with related experience

Preferred:

Experience:

Required:

Minimum of 5 years of demonstrated experience in Revenue Cycle in a Hospital setting ( i.e. Finance, Registration, Utilization Review/ Case Management) and experience and understanding of Federal/ State and other regulatory billing requirements. Must have demonstrated ability to develop and present analytical reports, develop process improvement plans related to the report findings, prioritize task and adhere to deadlines and required timeframes. Must be detail oriented with demonstrated accountability and strong organizational skills.

Preferred:

Position Requirement(s): License/Certification/Registration

Required:

CPAR

Preferred:

Department Position Summary:

The Revenue Integrity Coordinator is responsible for the tracking, trending and reporting of all Federal/Regulatory Integrity Audits received into the Erlanger Health System. Integrity audits include requests from the following: all requests from the Fiscal intermediary (FI) or Medicare Administrative Contractor (MAC), including Additional Development Requests (ADR) and Large Dollar Claims as determined by FI/MAC; Recovery Audit Contractor requests (RAC); Medicaid Integrity Program Requests (MIP); Zone Program Integrity Contractor Requests (ZPIC); KePro requests, and any other claims audits performed by third party payers. The position also works to identify underpaid or problematic Medicare accounts and communicates back to the Business Office those accounts expecting additional reimbursement. The Revenue Integrity Coordinator will assist the Revenue Integrity Manager in the reporting of data to the Erlanger Executive Management Team, including developing the data trending reports.

This position will also be responsible for tracking and submitting Medicare appeals as directed, as well as submission and tracking of ED medical necessity appeals at all levels. Additionally, the RI coordinator will be responsible for any tracking software used by the department for monitoring and tracking appeals and audit activity, communicating to RI staff regarding upcoming timeframes as well as the responsibility for uploading documentation required for submission to overflow appeals vendors for medical necessity, clinical validation DRG audits.

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