Revenue Integrity Specialist (Hybrid)

University of Toledo; Toledo (OH); Hybrid; USD 60,000 - 85,000; Full time

Job summary

University of Toledo Physicians seeks a Revenue Integrity Specialist II to advance denial management and ensure accurate claim submission. This hybrid role communicates issues and trends to stakeholders and works independently to plan efforts impacting reimbursement and reducing denials.

The position emphasizes reviewing denials, coding compliance, and collaboration with the coding and billing team to improve the revenue cycle. 403B, pension, and tuition benefits apply.

Qualifications

• Education: High-school diploma or equivalent.
• Certification: Current coding certification (CPC, CPC-H, CCS-P, RHIT, CCA, etc.) or willingness to obtain within 12 months.

Responsibilities

• Identify denial patterns and escalate to management as appropriate.
• Make recommendations for changes to work queues and claim edits to reduce denials.
• Review payer communications and policies to identify potential coding issues.
• Identify opportunities for coding and documentation process improvement.
• Identify root causes of denials.
• Review denied claims for correct coding and resubmit as needed.
• Provide regular feedback to team members and educators.
• Collaborate with billing/coding management to rectify concerns.
• Ensure effectiveness of pre-bill edits and clean claims.
• Maintain knowledge of regulations and payer policies.

Skills

Independent work

Communication

Organizational skills

Analytical thinking

Microsoft Office

Prioritization

Team collaboration

Judgment & problem solving

Confidential handling

Education

High-school diploma or equivalent

Coding certification (CPC, CPC-H, CCS-P, RHIT, CCA, etc.)

Tools

EPIC

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Revenue Integrity Specialist (Hybrid)

Revenue Cycle Main Full Time Corporate Toledo, OH, US

University of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family. The primary site of inpatient care services is at the University of Toledo Medical Center, but many of our physicians’ practice at hospitals and medical offices throughout the region.

University of Toledo Physicians offers competitive pay and benefits including: 403B, Pension, health and tuition waiver at UT.

POSITION SUMMARY

The Revenue Integrity Analyst II performs advanced level work related to clinical denial management and ensuring accurate claim submission. This position works within the Revenue Integrity Department and is responsible for communicating issues and trends related to denial management such as, but not limited to missing documentation, inaccurate coding, coding opportunities, and any other opportunities that might emerge as a result of analysis. The Revenue Integrity Analyst II will actively manage, maintain, and communicate denial/appeal activity to appropriate stakeholders. This individual will work independently to plan and organize efforts that directly impact reimbursement and reduce denials.

ESSENTIAL JOB FUNCTIONS AND ACCOUNTABILITIES

• Identify denial patterns and escalate to management as appropriate.
• Make recommendations for additions/ revisions to work queues, claim edits and potentially workflows to improve efficiency and reduce denials.
• Review payer communications and policies to identify potential changes or concerns related to coding initiatives; accelerate potential issues to appropriate parties.
• Identify opportunities for coding and documentation process improvement and actively participate in completing these initiatives.
• Identify root cause of denials.
• Reviews denied claims to ensure coding was appropriate, make corrections and resubmit when/as needed.
• Provides regular feedback to team members and coding/physician educators.
• Assists and collaborates with coding and billing manager to identify and rectify coding concerns.
• Responsible for reviewing effectiveness of coding related pre-bill edits to ensure claims are clean and error free.
• Will maintain current knowledge of regulations and payer policies, including LCDs.
• Will maintain current coding certification.
• All other duties as assigned

REQUIRED QUALIFICATIONS

• Education: High-school diploma or equivalent
• Certification: Current certification from an accredited coding association (CPC, CPC-H, CCS-P, RHIT, CCA, etc.) or willingness to obtain within twelve (12) months of hire.
• Skills
  • Demonstrated ability to work independently
  • Excellent communication and interpersonal skills.
  • Strong organizational and task management skills.
  • Strong critical thinking and analytical skills
  • Proficient in Microsoft Office products.
  • Ability to navigate shifting workflows and priorities.
  • Ability to work collaboratively in a team-oriented environment, courteous and friendly demeanor.
  • Ability to exercise sound judgment and problem-solving skills.
  • Ability to handle patient and organizational information in a confidential manner.

Work Experience

• 6+ years' experience in resolving insurance denials, coding, and/or revenue cycle.
• EPIC experience

WORKING CONDITIONS

• Works in a professional office environment that is well lit and well ventilated; and the equipment and materials needed to perform job duties are supplied.

The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.