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Revenue Cycle Integrity Specialist
2 months ago
Position Summary
Sovah Health is seeking a dedicated professional to oversee and enhance revenue cycle integrity operations. This role involves developing systems to manage medical necessity denials and creating tracking mechanisms to assess performance across service lines, payers, and providers.
Key Responsibilities:
- Maintain comprehensive documentation and tracking of all RAC and payer audit requests, ensuring compliance with timelines.
- Manage the submission of medical records and respond effectively to denial and appeal requests.
- Communicate RAC findings with relevant stakeholders within the organization.
- Coordinate multiple RAC notifications at various stages of appeal based on received feedback.
- Log and manage all government correspondence, ensuring all relevant parties are notified and informed.
- Collaborate with various departments to develop and document processes that facilitate efficient automated billing of hospital claims.
- Provide education and competency assessments to staff impacting the revenue cycle.
- Work closely with clinical departments and business office personnel to ensure accurate charging and coding of patient claims for optimal reimbursement.
- Assist with SOX audits, insurance denial appeals, and address patient charge inquiries as necessary.
- Contribute to the development of policies and procedures to ensure compliance within the revenue cycle.
- Engage in resolving revenue cycle issues and refining processes to mitigate future challenges.
- Stay updated on current trends and regulatory changes in healthcare revenue cycles.
- Verify insurance benefits and obtain necessary precertifications or authorizations.
- Conduct medical necessity checks when appropriate.
- Provide coverage in other registration areas as needed.
About Us:
People are our passion and purpose. At Sovah Health – Martinsville, we value our employees for their unique contributions. Our facility is a licensed 220-bed acute-care hospital offering a wide range of medical specialties, including home health, hospice, advanced wound healing, and oncology services.
Why Join Us:
- Comprehensive health benefits (Medical, Dental, Vision) and 401K for full-time employees.
- Generous Paid Time Off and Extended Illness Bank for full-time employees.
- Employee Assistance Program focusing on mental, physical, and financial wellness.
- Tuition reimbursement and assistance for eligible candidates.
- Opportunities for professional development and mentorship.
- And much more...
Minimum Qualifications:
Education: High school diploma or equivalent required; college education or two years of relevant experience preferred.
Skills: Strong critical thinking, judgment, and the ability to work independently in a fast-paced environment. Knowledge of hospital billing processes, insurance practices, and regulations is essential. Proficiency in HCPC/CPT/UB04 coding, reimbursement analysis, and excellent communication skills are required. Strong organizational skills and the ability to multitask are necessary.
Experience: Preferred two years of experience in hospital revenue cycle management. Familiarity with patient accounting management and billing systems is advantageous.
EEOC Statement: Sovah Health - Martinsville is committed to providing equal employment opportunities and complies with all applicable laws prohibiting discrimination based on various protected characteristics.
We are an equal opportunity employer and encourage diversity in our workforce.
