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Revenue Integrity Specialist
2 months ago
We are seeking a highly skilled Revenue Integrity Specialist to join our team at Sovah Health - Martinsville. The successful candidate will be responsible for coordinating, evaluating, and measuring revenue integrity operations, developing systems to manage medical necessity denials, and tracking mechanisms to measure loss leaders and improvements by service line, payer, and provider.
Key Responsibilities- Document and track all RAC and Payer audit requests, including maintaining the RAC and Arthur Databases to ensure timely compliance.
- Manage the submission of records and respond to denials and appeals requests.
- Share RAC findings with key members of the organization.
- Coordinate and manage numerous RAC notifications in varying phases of appeal based on feedback.
- Log, notify, and scan all Government correspondence coming into the facility, ensuring that all appropriate parties are informed.
- Work with departments that impact the hospital's ability to develop and document processes that facilitate clean automated billing of hospital claims.
- Collaborate with Scheduling, Registration, Clinical Departments, Health Information Management, and the Business Office to ensure all staff that impact the revenue cycle receive needed education and competency assessment.
- Work directly with clinical operating departments, Managed Care & Reimbursement, Supply Chain, and business office personnel to ensure the hospital receives all reimbursement to which it is entitled.
- Assist with SOX audits, insurance denial appeals, and patient charge concerns/complaints as needed.
- Participate in the development of policies and procedures and ensure compliance within the Revenue Cycle.
- Participate and collaborate in the resolution of Revenue Cycle issues and refinement of the process to prevent future issues.
- Stay informed of current healthcare-revenue cycle trends and regulatory changes.
- Verify insurance benefits and obtain precertification/authorization as necessary.
- Perform medical necessity checks, when appropriate.
- Provide coverage to other areas of registration when necessary.
- High school diploma or equivalent required; college education or 2 years' experience preferred.
- Critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
- Knowledgeable and experienced with Hospital bill processing and insurance practices.
- HCPC/CPT/UB04 experience, modifiers, Medicare APC's, and billing regulations required.
- Experience in reimbursement analysis, good written and verbal communication skills, demonstrated knowledge of Medical Terminology, strong organizational skills, and the ability to multi-task.
- Strong computer skills, including Excel, and the ability to interact positively with internal and external customers.
- Skills in researching and resolving problems, issues, and the ability to articulate audit findings.
- Able to perform work duties with minimal supervision.
We are a 220-bed, full-service, acute-care hospital providing over 22 medical specialties. Our team is passionate about delivering exceptional patient care and creating a positive work environment. We offer a range of benefits, including health insurance, 401K, and tuition reimbursement. If you are a motivated and detail-oriented individual who is passionate about healthcare, we encourage you to apply for this exciting opportunity.