Job Description
TITLE/POSITION: REVENUE INTEGRITY SPECIALIST DEPARTMENT OR BUSINESS UNIT: RCM REPORTING STRUCTURE: MANAGER, REVENUE OPTIMIZATION & TRAINING EMPLOYMENT TYPE: FTE EXEMPTION STATUS: EXEMPT MIN. EXPERIENCE: 5+ YEARS TRAVEL REQUIRED: YES
OVERVIEW OF THE ROLE:
UNDER THE DIRECTION OF THE MANAGER OF REVENUE OPTIMIZATION AND TRAINING DEPARTMENT, THE REVENUE INTEGRITY SPECIALIST IS RESPONSIBLE FOR ENSURING ACCURATE AND TIMELY PAYMENTS FROM PAYERS IN COMPLIANCE WITH CONTRACTS AND GOVERNMENT FEE SCHEDULES VIA THE USE OF TRIZETTO (CONTRACT SYSTEM RECEIPT BY 835), MICROSTRATEGY (ANALYTICS PLATFORM) AND MANUAL AUDITS WITHIN ATHENA (RCM SYSTEM). ADDITIONALLY, THE RI SPECIALIST IS RESPONSIBLE FOR IDENTIFYING AND MAXIMIZING ALL POTENTIAL REVENUE OPPORTUNITIES FOR THE CARE CENTERS AND ANSWERING CONCERNS PROMPTLY. THIS POSITION ANALYZES AND PREPARES TO REPORT ON RELEVANT DENIAL TRENDS, DETERMINES THE ROOT CAUSES OF DENIALS, AND WORKS WITH THE APPROPRIATE DEPARTMENTS TO ESTABLISH PROCESSES TO MITIGATE DENIALS. THIS POSITION WORKS COLLABORATIVELY WITH MANAGEMENT AND STAFF AND ROUTINELY FOLLOWS ACCEPTED SAFETY PRACTICES.
PRIMARY JOB DUTIES:
ANALYZE, AUDIT AND PROVIDE SOLUTIONS TO INSURANCE REJECTIONS OR DENIALS
REPORT OUT ON NEGATIVE IMPACTS AND TRENDS TO THE PHYSICIAN REVENUE
EFFECTIVELY COMMUNICATE AND TRAIN CARE CENTERS STAFF ON REVENUE CYCLE OPPORTUNITIES
OTHER DUTIES AND SPECIAL PROJECTS AS ASSIGNED BY THE RCM OPTIMIZATION & TRAINING MANAGER, AND ASSOCIATE VP OF RCM
Qualifications
EDUCATION: HIGH SCHOOL GRADUATE, MEDICAL OFFICE TRAINING CERTIFICATE OR (SEE EXPERIENCE).
EXPERIENCE: 5+ YEARS EXPERIENCE WITH PAYER CONTRACTS AND AUDITING.
EXPERIENCE: 5+ YEARS EXPERIENCE IN MEDICAL BILLING OFFICE
MUST COMPLY WITH HIPAA RULES AND REGULATIONS
INTERPERSONAL SKILLS & ATTRIBUTES:
EXCELLENT WRITTEN AND VERBAL COMMUNICATION
EXPERIENCE IN A PEOPLE MANAGEMENT FUNCTION
ADVANCED UNDERSTANDING TO TRAIN AND COACH OTHER TEAM MEMBERS
MAJOR CONTRIBUTOR TO DEPARTMENTAL GOALS WITH GREAT TIME MANAGEMENT SKILLS
ASSISTS DEVELOPING SOLUTIONS TO A VARIETY OF ISSUES WHICH MAY BE OCCASIONALLY COMPLEX AND ENSURE TEAM AND COMPANY GOALS ARE MET.
ABILITY TO WORK INDEPENDENTLY AND MULTI-TASK IN A FAST PACED ENVIRONMENT
TECHNICALLY CAPABLE AND SAVVY
Additional Information
PHYSICAL DEMANDS:
ABILITY TO CONSTANTLY REMAIN IN A STATIONARY POSITION
ABILITY TO STAND FOR 4+ HOURS AS NEEDED
ABILITY TO CONSTANTLY OPERATE A COMPUTER AND OTHER OFFICE PRODUCTIVITY MACHINERY, SUCH AS COMPUTER AND PRINTER
ABILITY TO READ AND USE CLOSE VISION, INCLUDING THE ABILITY TO DO SO ON A COMPUTER SCREEN
ABILITY TO FREQUENTLY COMMUNICATE AND EXCHANGE INFORMATION
ABILITY TO FREQUENTLY ADJUST FOCUS
ABILITY TO MOVE ABOUT THE OFFICE OR TO OTHER LOCATIONS AS NEEDED
ABILITY TO OCCASIONALLY POSITION SELF TO MAINTAIN EQUIPMENT OR MATERIALS INCLUDING UNDER DESKS OR IN CLOSETS
ABILITY TO LIFT, PUSH, AND/OR PULL UP TO 25 POUNDS, USUALLY IN THE FORM OF BOXES, EQUIPMENT OR OTHER SMALL PACKAGES
All your information will be kept confidential according to EEO guidelines.
TECHNICAL REQUIREMENTS (FOR REMOTE WORKERS):
IN ORDER TO SUCCESSFULLY WORK REMOTELY, SUPPORTING OUR PATIENTS AND PROVIDERS, WE REQUIRE A MINIMUM OF 5 MBPS FOR DOWNLOAD SPEED AND 3 MBPS FOR THE UPLOAD SPEED. THIS SHOULD BE ACQUIRED PRIOR TO THE START OF YOUR EMPLOYMENT. THE BEST MEASURE OF YOUR INTERNET SPEED IS TO USE ONLINE SPEED TESTS LIKE HTTPS://WWW.SPEEDTEST.NET/. THIS GIVES YOU AN UPDATE AS TO HOW FAST DATA TRANSFER IS WITH YOUR INTERNET CONNECTION AND IF IT MEETS THE MINIMUM SPEED REQUIREMENTS. WORK WITH YOUR INTERNET PROVIDER IF YOU HAVE QUESTIONS ABOUT YOUR CONNECTION. EMPLOYEES WHO REGULARLY WORK FROM HOME OFFICES ARE ELIGIBLE FOR EXPENSE REIMBURSEMENT TO OFFSET THIS COST.