Revenue Integrity Clinical Systems Specialist

01 Silver Cross Hospital and Medical Centers; New Lenox (IL); On-site; USD 36,000 - 44,000; Full time

Benefits offered by this job

Medical, Dental and Vision plans

Life Insurance

401(k) plan with match

PTO and Sick time

Wellness program

Tuition Reimbursement

Job summary

Silver Cross Hospital is seeking a Billing Policy Analyst to monitor charging policies and practices across departments, communicate implications to clinical and non-clinical leaders, and support compliant reimbursement.

The role involves auditing insurance processes, educating staff on billing policies, and maintaining the charge master in collaboration with leadership. Prior experience in patient accounting and intermediate Excel skills are required.

Qualifications

• Associate of Science degree in a medically related field.
• Minimum of two years' experience in a patient accounting environment.
• Intermediate Excel skills.
• Bachelor’s degree in Accounting or BSN strongly preferred.
• Licensure/certification: IL RN licensure or RHIT/RHIA/CCS for coders.

Responsibilities

• Monitor and analyze charging policies and practices for all hospital departments and communicate to clinical and non-clinical management to optimize reimbursement.
• Conduct and complete insurance audits through site visits by insurance auditors.
• Act as a liaison and interpreter of clinical information as it relates to billing to patients and all departments.
• Educate staff on billing policies and keep up to date on reimbursement and denial trends.
• Update and maintain the Charge Master in collaboration with clinical departments, Patient Accounts Management, Revenue Cycle Leadership, and Accounting.
• Appeal clinical denials and assist in obtaining authorizations for current in-house patients.

Skills

Microsoft Excel

Education

Associate of Science Degree in a medically related field

Bachelor’s Degree in Accounting or BSN strongly preferred

Job description

Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve… for each other. Come join us! It’s the way you want to be treated.

Summary

Directly responsible for monitoring and analyzing charging policies and practices for all hospital departments and applying and communicating that knowledge to both clinical and non‑clinical management in order to facilitate correct and compliant charging and optimize reimbursement. Responsible for conducting and completing insurance audits through site visits by insurance auditors. Acts as a liaison and interpreter of clinical information as it relates to billing to patients, and all departments within Silver Cross Hospital. Analyzes and identifies breakdowns in processes that have financial impacts and coordinates appropriate work groups to resolve the issues. Educates clinical and non‑clinical staff on billing policies. Keeps up to date on reimbursement and denial trends. Works cooperatively with clinical leaders to develop and improve charge capture and documentation. Updates and maintains Charge master in collaboration with the clinical departments, Patient Accounts Management, Revenue Cycle Leadership, and Accounting. Manage Managed Care Organization (MCO) authorized services to both the inpatient and outpatient population. Ensure correct coding providing feedback to billing and collection staff when questions arise. Appeal clinical denials, regardless of the denial source; appeals will be both verbal and written. Assist in obtaining authorizations for current inhouse patients.

Requirements

• An Associate of Science Degree in a medically related field.
• Minimum of two years of previous experience in a Patient Accounting environment.
• Microsoft Excel – intermediate level of skill.
• Bachelor’s Degree in Accounting or Bachelors of Science in Nursing strongly preferred.
• Required License and/or Certification: a. If RN, current State of Illinois licensure b. If coder, Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS)

Work Shift Details

• Days, Days, Monday through Friday

Benefits for You

At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members. Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:

• Medical, Dental and Vision plans
• Life Insurance
• Flexible Spending Account
• Other voluntary benefit plans
• PTO and Sick time
• 401(k) plan with a match
• Wellness program
• Tuition Reimbursement

Registry employees who meet eligibility may participate in our 401(k) Savings plan with a potential match. However, registry employees are ineligible for Health and Welfare benefits.

The expected pay for this position is listed below: $25.84 - $32.30 The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.

INSPIRING HEALTHY RELATIONSHIPS THROUGH AN INCLUSIVE CULTURE AT SILVER CROSS. Silver Cross