Revenue Integrity Specialist

Davita Inc.; Des Moines (IA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Revenue Cycle Integrity Specialist to enhance revenue cycle operations and performance. This full-time remote position focuses on resolving billing issues, improving processes, and collaborating with various departments to ensure efficient revenue management. A strong candidate will have experience in medical billing and effective decision-making skills.

Benefits

Paid time off

401K matching

Health and dental insurance

Tuition reimbursement

Adoption assistance

Qualifications

• 2+ years of experience in revenue cycle or medical billing.
• Proficiency with large datasets and decision-making related to revenue processing.
• Knowledge of medical terminology and coding essential.

Responsibilities

• Resolve billing errors and ensure timely claim filing.
• Collaborate with stakeholders to improve revenue cycle functions.
• Monitor data and provide feedback for performance improvements.

Skills

Professionalism

Interpersonal Skills

Effective Communication

Process Improvement

Decision-Making Skills

Education

H.S. diploma/GED

Bachelor's degree in Healthcare Administration, Business, Mathematics, or Computer Science

Tools

Epic

Microsoft Office

Job description

• Remote: Yes
• Area of Interest: Business Professionals
• FTE/Hours per pay period: 1.0
• Department: Clinical Documentation
• Shift: Days
• Job ID: 166410

Overview

Revenue Cycle Integrity Specialist

Days, Full-time. No weekends or Holidays

This position is open to remote/work from home with a preference for candidates residing within the UPH geographies of Iowa, Illinois, & Wisconsin.

We are seeking a Revenue Cycle Integrity Specialist to join our team! This role is a key member of the Revenue Cycle Team, reporting directly to the Manager of Revenue Integrity. The position is responsible for working work queues, identifying trends, and collaborating with departments to improve revenue cycle performance within UnityPoint Health. It requires strong decision-making skills regarding charging issues, complex claims processing workflows, and regulations, utilizing data from multiple sources. The specialist will evaluate charging and billing issues, understand the entire Revenue Cycle, and interact with leadership, revenue cycle staff, coding staff, billing staff, and IT teams.

This individual will focus on supporting continuous improvement in key revenue cycle functions including Registration, Coding, and Billing. Maintaining good relationships with all affiliates is essential to ensure clear communication and collaborative implementation of best practices.

Why UnityPoint Health?

At UnityPoint Health, you matter. We are recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. Our Total Rewards program offers benefits such as paid time off, parental leave, 401K matching, employee recognition, health and dental insurance, paid holidays, disability coverage, pet insurance, early wage access, tuition reimbursement, and adoption assistance. We promote a culture of belonging, valuing diversity and fostering growth through support and development opportunities.

Find a fulfilling career and make a difference with UnityPoint Health.

Responsibilities

Revenue Cycle Specialist

• Resolve billing errors/edits, charge review edits, and claim edits, including accounts with Stop Bills and "DNBs," to ensure timely claim filing.
• Make decisions to improve charge issues, claims processing workflows, and compliance with regulations.
• Provide information to leadership regarding charging issues, claim problems, errors, and payer trends to expedite claims adjudication.
• Analyze data to identify opportunities for process improvement and assist in developing accountability reports to drive change.
• Collaborate on revenue cycle projects with key stakeholders across UnityPoint Health, impacting business operations.
• Interpret revenue cycle policies and recommend improvements.
• Maintain an in-depth understanding of the revenue cycle, troubleshoot registration, coding, and CCI edits.
• Research and resolve charge review, claim edit, and denial issues in work queues.
• Serve as a liaison for billing team members, answering questions and troubleshooting accounts as needed.

Performance Monitoring/Revenue Integrity

• Apply revenue cycle principles to ensure accurate and compliant billing.
• Monitor, analyze data, and provide feedback to management for performance improvement.
• Identify billing errors or omissions and track data to enhance revenue cycle performance.
• Work with Revenue Integrity Analysts and Directors to prioritize recommendations.
• Identify training opportunities and provide training to improve operations.

Denials Management

• Work with leadership and staff to identify and remediate denials through rules and EMR build.
• Assist with performance tracking reports.
• Understand complex insurance rules, appeals, trends, and recommend system changes accordingly.
• Understand factors leading to denials and revenue loss across the entire revenue cycle.

Qualifications

Education

• H.S. diploma/GED required
• Bachelor's degree in Healthcare Administration, Business, Mathematics, or Computer Science preferred

Experience

• At least 2 years of progressive experience in revenue cycle or medical billing

Knowledge/Skills/Abilities

• Professionalism, interpersonal skills, effective communication, and process improvement skills
• Proficiency with Epic and Microsoft Office, ability to manipulate large datasets
• Decision-making skills related to revenue processing and accuracy
• Knowledge of the revenue cycle, medical terminology, and coding