Contracting and Revenue Integrity Specialist

Mile Bluff Medical Center; Mauston (WI); On-site; USD 65,000 - 90,000; Full time

Job summary

Mile Bluff Medical Center in Wisconsin is seeking a Contracting and Revenue Integrity Specialist to support the CFO in payer contracting, reimbursement analysis, and revenue optimization across hospital, clinics, nursing homes, and retail pharmacies. The role maintains the CDM, analyzes reimbursement impacts, and assists with contract negotiations to ensure compliant, optimal charging practices.

The position requires collaboration with Administration, Finance, Patient Financial Services, Clinic

Qualifications

• Associate degree or higher in business, accounting or healthcare admin preferred.
• Experience with chargemaster management and revenue integrity required.
• Knowledge of Medicare/Medicaid, CMS and payer contract expectations.

Responsibilities

• Coordinate negotiation, renewal, and implementation of managed care contracts with payers.
• Review care agreements and analyze reimbursement methodologies and pricing.
• Perform financial analyses to assess impact of contract terms.
• Maintain payer contract files and renewal schedules.
• Develop reimbursement and contract performance reports for CFO.
• Maintain CDM and update charging structures.
• Coordinate enrollment and revalidations for providers with payers.
• Identify opportunities to improve charge capture and reimbursement accuracy.
• Monitor billing compliance and payer requirements.

Skills

Payer contracting

Reimbursement analysis

Charge Description Master (CDM)

Regulatory compliance

Financial reporting

Contract negotiations

Microsoft Excel

Healthcare financial tools

Education

Associate degree in Business Administration

Associate degree in Accounting

Associate degree in Healthcare Administration

Tools

Microsoft Excel

Healthcare financial reporting tools

Job description

General Information

Job title: Contracting and Revenue Integrity Specialist

Schedule: 80 hours per pay period; Monday - Friday - 8:00am to 4:30pm

Weekend Requirement: No weekends

Holiday Requirement: Paid holidays

Position Summary

The Contracting and Revenue Integrity Specialist supports the Chief Financial Officer in managing payer contracting activities, reimbursement analysis, and revenue optimization initiatives for the hospital and affiliated clinics, nursing homes, and retail pharmacies. The position is responsible for maintaining the organization's Charge Description Master (CDM), monitoring reimbursement performance, supporting contract negotiations, and ensuring compliance with applicable billing and regulatory requirements.

This role serves as a key liaison between Administration, Finance, Patient Financial Services, Clinic Operations, Compliance, and Clinical Departments to promote accurate charging, maximize reimbursement, and maintain the financial integrity of Mile Bluff Medical Center services.

Position Responsibilities

• Assist the CFO by coordinating negotiation, renewal, and implementation of managed care contracts with commercial insurers, Medicare Advantage plans, Medicaid Managed Care Organizations, and other payers.
• Review care agreements and analyze reimbursement methodologies, fee schedules, and payment policies.
• Perform financial analyses to assess the impact of proposed contract terms and reimbursement changes.
• Maintain payer contract files, renewal schedules, and reimbursement documentation.
• Develop reimbursement and contract performance reports. Prepare reports and recommendations for CFO regarding contract performance and reimbursement trends.
• Maintain and update the medical center Charge Description Master (CDM).
• Coordinate annual and ongoing reviews of charge structures, HCPCS, CPT, revenue codes, and pricing. Ensure compliance with Medicare, Medicaid, commercial payer, and regulatory billing requirements.
• Collaborate with department leaders to establish charges for new services, procedures, equipment, and supplies. Monitor coding and billing changes impacting charge capture and reimbursement.
• Identify opportunities to improve charge capture and reimbursement accuracy.
• Monitor compliance with billing regulations and payer requirements.
• Analyze reimbursement impacts related to new services and programs.
• Support regulatory audits and documentation requests.
• Coordinate enrollment, revalidation, and maintenance activities for hospital and clinic providers with Medicare, Medicaid, commercial payers and managed care organizations.
• Add newly hired providers to managed care contracts and payer networks in a timely manner to prevent reimbursement delays.
• Serve as the organization's primary administrator for Medicare Provider Enrollment, Chain, and Ownership System (PECOS) activities. Maintain hospital, clinic, and provider enrollment records within PECOS.
• Maintain organizational and provider enrollment records within Wisconsin Forward Health.
• Coordinate Medicare, Medicaid, and Commercial payer revalidations, ownership updates, provider additions and deletions, practice location changes, and other enrollment actions.
• Perform other duties as requested.

Position Requirements

• Associate degree in Business Administration, Accounting, Healthcare Administration preferred.
• Minimum three years of experience in healthcare finance, reimbursement, managed care contracting, chargemaster management, revenue integrity, revenue cycle or related healthcare operations required.
• Experience with Rural Health Clinics or rural healthcare organizations preferred.

Knowledge, Skills, & Abilities

• Knowledge of hospital and clinic reimbursement methodologies.
• Understanding of Medicare, Medicaid, commercial insurance and managed care contracts.
• Knowledge of chargemaster maintenance, charge capture, CPT/HCPCS coding and revenue codes.
• Strong analytical and financial modeling skills.
• Advanced proficiency in Microsoft Excel and healthcare financial reporting tools.
• Ability to interpret contractual language and reimbursement methodologies.
• Strong organizational, communication and project management skills.
• Ability to manage multiple priorities and work independently.

Why Mile Bluff Medical Center?

Mile Bluff Medical Center is a place where people come first. Our team is comprised of caring, patient-centered professionals serving pediatric through geriatric populations in our rural community. Our not-for-profit organization prides itself on providing state-of-the-art healthcare services, a positive work environment, and a team where employees feel valued and supported. Mile Bluff is an independent organization that offers competitive wages, great benefits and the opportunity for growth. Mile Bluff makes decisions for its employees and patients locally without relying on a large health system in another community.