Revenue Integrity Specialist
3 days ago
Schedule: Monday - Friday, 8am - 4:30pm
Hybrid Role: 3 days onsite
Location: Skokie, IL
The RCM Revenue Integrity Specialist is primarily responsible for maximizing reimbursement through monitoring and analyzing the charging policies and practices for all clinical departments. The professional in this role is also responsible for communicating the charging policies and practices knowledge to both clinical and non-clinical management in order to facilitate correct and compliant charging process and optimize reimbursement.
Revenue Integrity Specialist will also analyze and identify breakdowns in processes that have financial impacts and lead appropriate changes to resolve the issues
Essential Responsibilities
- Audit claims, charge capture, and billing workflows for accuracy and compliance.
- Review all billing manuals and provider manuals regularly; communicate updates to leadership.
- Collaborate with clinical staff to ensure documentation supports billing requirements; provide education when needed.
- Monitor denial trends, escalate systemic issues, and recommend solutions.
- Partner with Billing & Collections Supervisor and Network Administrator to ensure EMR fee schedules and codes are current.
- Ensure all new payer billing processes are correctly configured and tested in the clearinghouse prior to claim submission.
- Support payer audits, compliance reviews, and special projects.
- Attend payer webinars, provider calls, and training sessions to stay up to date on policy changes, billing requirements, and compliance updates; communicate updates to leadership
- Develop recommendations for reducing denials and improving revenue capture.
- Maintain and update documentation of revenue integrity processes, audit findings, and compliance workflows.
- Perform other duties and projects as assigned.
- Bachelor's degree in Finance, Psychology, Social Work, Counseling, Behavioral Health, or other closely related field highly preferred
- Minimum 10 years of experience in the healthcare industry (particularly Medicaid and Managed Medicaid insurance companies)
- Minimum of 3 years of Healthcare Revenue Cycle Management experience, in a leadership role
- Experience with ICD-10 coding. Billing and Coding certification is highly preferred
- Prior experience with Lean Six Sigma and Process Improvement methodology preferred
- Experience with CareLogic system preferred
- Strong understanding of Microsoft applications; i.e. Excel, Outlook, Access, Word
- Ability to investigate problems and develop/communicate solutions
- Excellent oral, written, and interpersonal communication skills with a focus on customer service
- Ability to meet deadlines; highly detailed oriented; strong financial analysis and organizational skills; and analytical mindset with intellectual curiosity
- Ability to act and operate independently with minimal supervision
- FREE Virtual Primary Care, Urgent Care, and Mental Health Counseling for ALL Employees
- PAID Maternity/Paternity leave
- Medical Insurance (BCBS of IL)
- Dental Insurance
- Vision Insurance
- Life Insurance
- Long-Term & Short-Term Disability
- Pet Insurance
- FSA (Health, Dependent Care, Transit)
- Telemedicine
- EAP
- 403(b) Retirement Plan with Employer Match
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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