Revenue Integrity Specialist

Revenue Integrity Specialist - Professional Billing * Days - 40hrs/wk.

Requisition #: req834

Shift: Days

FTE status: 1

On-call: No

Weekends: No

General Summary:

The Revenue Integrity Specialist ensures the financial integrity of provider billing and accounts receivable by performing established financial processes ensuring compliance with billing guidelines while expediting the billing and collection of professional services. In addition the Revenue Integrity Specialist will support providers and site staff through ongoing training related to documentation, coding and revenue capture. Communicate opportunities for improvement to the appropriate CIN sub-committees.

Requirements:

1. Excellent communication skills in both written and verbal formats. Excellent organization and problem-solving skills required. Incumbent must be comfortable discussing and collecting money and discussing financial matters with patients/payers in a professional manner
2. Demonstrated leadership ability, and record of effective team oriented relationships with hospital staff, managers, senior management and medical staff
3. Thorough knowledge of current trends and best practices in revenue cycle concepts
4. Intermediate computer application skills including with MS Windows, Word, and Excel
5. Ability to adapt to change and manage frequently changing workload or shifting of priorities
6. Ability to use critical thinking skills in problem solving

Qualifications:

1. High school diploma required with two years’ clinical and/or healthcare billing experience
2. CPC/CCS, or RHIT/RHIA within 12 months of hire
3. Working knowledge of CPT, ICD-10 coding and Federal/managed care rules and regulations

Essential Functions and Responsibilities:

1. Validate charge capture integrity through pre-billing charge and clinical documentation review
2. Work with providers to ensure documentation accuracy and implement documentation improvement best practices
3. Identify missing charge opportunities
4. Site support and training for registration, insurance, and WQs related to revenue capture
5. Ongoing provider education related to billing and coding requirements including annual review of CPT changes pertinent to assigned providers
6. Monitor denials and provide education to reduce denied claims
7. Work in conjunction with leadership to ensure incentive program measures are documented and met
8. Work in conjunction with Billing and Reimbursement staff to expedite billing and collection while ensuring accurate and compliant billing practices are maintained
9. Work in conjunction with Compliance Auditors for new provider billing training and education