Revenue Integrity Clinical Systems Specialist

silvercross; New Lenox (IL); On-site; USD 36,000 - 44,000; Full time

Benefits offered by this job

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

Job summary

Silver Cross Hospital is seeking a Patient Accounting specialist to monitor charging policies, analyze practices across departments, and communicate findings to clinical and administrative leaders. You will conduct insurance audits, educate staff on billing policies, and maintain the charge master to optimize reimbursement.

The role involves coordinating with revenue cycle leadership, managing MCO-authorized services for inpatients and outpatients, and assisting with authorizations for current

Qualifications

• An Associate of Science Degree in a medically related field is required.
• Minimum of two years of previous experience in a Patient Accounting environment is required.
• Microsoft Excel – intermediate level of skill is required.
• Bachelor’s Degree in Accounting or BS in Nursing is strongly preferred.
• Required License and/or Certification is required.
• If RN, current State of Illinois licensure.
• If coder, RHIT/RHIA or CCS certification is considered.

Responsibilities

• Directly responsible for monitoring and analyzing charging policies and practices for all hospital departments and communicating findings to clinical and non-clinical management.
• Conduct and complete insurance audits through site visits by insurance auditors.
• Act as liaison and interpreter of clinical information as it relates to billing to patients and hospital departments.
• Educate clinical and non-clinical staff on billing policies and keep up to date on reimbursement and denial trends.
• Update and maintain Charge master in collaboration with departments and Revenue Cycle Leadership.
• Manage MCO-authorized services for inpatients and outpatients; assist in obtaining authorizations for current in-house patients.

Skills

Excel

Education

Associate of Science Degree in a medically related field

Bachelor’s Degree in Accounting or BS in Nursing

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...and for each other.

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.
• If RN, current State of Illinois licensure.
• 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

Department

PATIENT ACCOUNTS

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.

Benefit Package

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.

Pay

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.