Revenue Integrity Specialist

Memorial Physician Practices; Northern (KY); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health insurance, dental, vision

401K Benefits

Competitive PTO

Employee Assistance Program

Tuition Reimbursement

Job summary

Starr Regional - Health and Rehab is seeking a Revenue Integrity Specialist to coordinate and measure revenue integrity operations. The role focuses on medical necessity denials, tracking losses by service line, payer, and provider, with reporting to the Patient Access Supervisor.

You will collaborate across Scheduling, Registration, Clinical Departments, Health Information Management, and the Business Office to ensure proper education and competency in revenue cycle processes.

Qualifications

• Two years' hospital revenue cycle experience preferred.
• Experience with coding (CPT, diagnosis, revenue and insurance codes) a must.
• Strong understanding of hospital charging and rate structure.

Responsibilities

• Document and track RAC and payer audit requests.
• Manage submission of records and respond to denials/appeals.
• Share RAC findings with key members and coordinate RAC notifications during appeals.
• Log and scan government correspondence and ensure appropriate parties are informed.
• Assist with process improvement and roll-out of revenue cycle solutions.
• Educate staff across departments to ensure revenue cycle readiness and competency.
• Ensure hospital receives appropriate reimbursement through proper charging and coding.
• Assist with SOX audits, insurance denial appeals and patient charge concerns.
• Develop and refine Revenue Cycle policies and procedures.
• Stay informed on healthcare revenue cycle trends and regulatory changes.

Skills

RAC auditing

Payer denials

Appeals management

Coding knowledge

Revenue cycle

Education

High school diploma or equivalent

College education or 2 years experience preferred

Tools

Billing systems

Coding software

Job description

Your experience matters

At Starr Regional - Health and Rehab is we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

• Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:
• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

Job Summary:

The Revenue Integrity Specialist coordinates, evaluates and measures revenue integrity operations; develops systems to manage medical necessity denials; and develops tracking mechanisms to measure loss leaders and improvements by service line, payer and provider. Reports to: Patient Access Supervisor

Essential Functions:

• Document and track all RAC and Payer audit requests including maintaining the RAC and Arthur Databases to ensure that all timelines are met.

• Manager the submission of records and respond to denials and appeals requests.

• Share RAC findings with key members of the organization. Coordinate and manage numerous RAC notifications in varying phases of appeal based on feedback.

• Log, notify, and scan all Government correspondence coming into the facility ensuring that all appropriate parties are informed.

• Maintains e-requests.

• Works with departments which impact the hospital's ability to develop and document processes which facilitate clean automated billing of hospital claims. This includes identification of people, process, and technology issues, development of appropriate solutions, participation in roll-out of the process improvement solutions, and ongoing monitoring. Will participate on existing teams and initiate and lead project teams as needed.

• Works with Scheduling, Registration, Clinical Departments, Health Information Management, and the Business Office to ensure all staff that impact the revenue cycle receive needed education and competency assessment. Assists in the preparation of educational material and provides education as needed.

• Works directly with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office personnel to ensure the hospital receives all reimbursement to which it is entitled through appropriate charging and coding of patient claims.

• Assists with SOX audits, insurance denial appeals and patient charge concerns/complaints as needed.

• Participates in the development of policies and procedures and ensures compliance within the Revenue Cycle.

• Participates and collaborates in resolution of the Revenue Cycle issues and refinement of the process to prevent future issues.

• Keeps informed of current healthcare-revenue cycle trends and regulatory changes.

• Verifies insurance benefits and obtains precertification/authorization as necessary.

• Determines and accepts required payments, including co-pays and deductibles, or refers to financial counselors for follow up.

• Performs medical necessity check, when appropriate (if not already done so in scheduling or pre-registration process).

• Able to provide coverage to other areas of registration when necessary.

Education/Experience:

High school diploma or equivalent Required. College education or 2 year's experience preferred.

Minimum Work Experience

Two years' hospital revenue cycle experience preferred. Physician billing/reimbursement experience helpful. Demonstrated expertise in patient accounting management and billing systems including their uses, capabilities and limitations. Experience with coding (CPT, diagnosis, revenue and insurance codes, etc.) and a working knowledge of billing regulations, including but not limited to Medicare IP PPS and OPPS, Medicaid and commercial billing guidelines, a must. Strong understanding of Hospital Charging and rate structure.

EEOC Statement:

Starr Regional- Health and Rehab is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.