Revenue Integrity Specialist I

BHS • Kentucky - Work from Home, IN

1d • Remote

About The Position

Baptist Health is looking for a Revenue Integrity Specialist I to join our team! This is a remote work position that requires residency in KY or IN. The role involves researching denials or audits from all commercial and governmental payors. The specialist will perform payor compliance reviews on accounts to determine the medical necessity of services, both pre and post-service, as well as pre and post-billing. This includes obtaining predeterminations, prior authorizations, and retro authorizations when required by the payor. The position requires responding to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss, all while meeting appropriate payor or government timelines. Recovery efforts may include written letters, emails, website interactions, and telephonic communication.

Requirements

• Bachelor’s Degree in related field, Practical Nurse License, or Coding Certification with two years of healthcare experience
• In lieu of Bachelor’s degree, five years of healthcare experience required including two years in a revenue cycle related area such as registration, patient financial services, or managed care.
• Knowledge of medical terminology
• Knowledge of payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines)
• Knowledge of payor denial appeal / payment variance resolution processes
• Knowledge of managed care contracts
• Keen understanding of all audit response requirements and timelines

Responsibilities

• Research denials or audits from all commercial and governmental payors.
• Perform payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing.
• Obtain predeterminations, prior authorizations, and retro authorizations when required by payor.
• Respond to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines.
• Conduct recovery efforts including written letters, emails, website interactions, and telephonic communication.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level