Revenue Integrity Specialist

Revenue Integrity Specialist

Full-Time Remote Position

Monday - Friday

General Summary: The Revenue Cycle Analyst provides analytic support, claims resolution, problem-solving, and communication with clinic departments on all matters pertaining to revenue cycle needs.

Duties and Responsibilities:

• Responsible for analyzing and presenting data in coordination with clinical and financial management goals, benchmarks, and objectives in assigned areas
• Complies daily with departmental policies and procedures
• Support and assist Hospital and Physician team members with difficult issues concerning work, clients and/or insurance carriers; offer suggestions to assist in process of underpayment reviews and collections
• Resolves claims processing issues with commercial and governmental payers and provide all required information timely; involves patients and family members (where necessary) to ensure timely resolution of claims with insurance companies
• Responsible for making sure the facilities understand the standard charging guidelines and how to correct charge errors going forward
• Resubmits clean and accurate claims to insurance companies in a timely and compliant manner
• Researches, prepares, and submits appeals to insurance companies
• Details all actions taken on account with clear and concise notes
• Monitors and recognizes denials and/or issues that may be trends and escalate to supervisor as needed
• Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations
• Perform various monitoring tasks that identify revenue integrity opportunities
• Working knowledge of Athena
• Works closely with Department management to facilitate root issue remediation
• Complete claims resolutions timely, accurately while meeting department benchmarks
• Present data, analysis, and recommendations for solutions in meetings with departmental management
• Reviews and analyzes "Explanation of Benefits" (EOBs), payer correspondences to identify denials that can be appealed. Perform denials analysis to reduce controllable rejections
• Perform deep-dive analysis to find solutions that can benefit multiple specialties
• Performs other duties as assigned

Knowledge, Skills and Abilities:

• Knowledge of basic medical coding/terminology and commercial/government insurance operating procedures and practices
• Understands payer guidelines related to effective claim resolution
• Knowledgeable and proficient with payer websites and other useful resources; Knowledge of revenue cycle and/or business office procedures
• Highly detail oriented and organized
• Ability to read, understand, and follow oral and written instructions
• Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Quorum Health Systems
• Strong verbal and written communication skills
• Ability to work independently and follow-through and handle multiple tasks simultaneously
• Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self-pay reimbursement concepts and overall operational impact
• Demonstrated advanced skills in A/R management, problem assessment, and resolution, and collaborative problem-solving in complex, interdisciplinary settings
• Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution
• Advanced skills in using excel to maneuver through large volumes of data

Work Experience, Education and Certifications:

• Education – High School Diploma or equivalent
• 5+ years in relevant Healthcare experience

Travel Requirements:

• Travel is infrequent

This job description is not to be construed as a complete listing of the duties and responsibilities that may be given to any employee. The duties and responsibilities outlined in this position may be added to or changed when deemed appropriate and necessary by the person who is managerially responsible for this position.

Equal Opportunity Employer

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