Revenue Integrity Specialist

Silver Cross Hospital•Cheyenne, WY

3d•$22 - $27

About The Position

The Revenue Integrity Specialist works with the Revenue Integrity Coordinator to promptly and accurately resolve charging issues. The role reviews charging reports and resolves issues such as charge rejections between Cerner and Meditech, charges on incomplete or miscellaneous accounts, late charges, missing emergency department evaluation and management charges, room-and-board discrepancies, and observation charging issues. The specialist identifies payer requests related to bill accuracy, length of stay, level of care, medical necessity, and coding; documents payer correspondence; and coordinates the timely submission and follow-up of audit appeals and disputes with team members. The role maintains reports and appeal statistics for management, assists with large-scale account corrections alongside the Revenue Integrity Coordinator and Corporate Compliance, and supports research and education regarding medical policies and denials. The specialist also assists patients with service estimates as requested.

Requirements

Demonstrate tact and diplomacy in interpersonal interactions and maintain composure in confrontational situations.
Strong oral and written communication skills.
Analytical and problem-resolution skills.
Customer service skills.
Ability to adhere to work plans and manage resources to complete daily workflow and goals successfully.
Maintain current knowledge of relevant regulatory requirements, payer regulations, policies, and procedures.
Strong knowledge of Excel.

Nice To Haves

Bachelor’s degree in Business, Healthcare, Finance/Accounting, or a related field.

Responsibilities

Review and resolve daily charge rejections from Cerner to Meditech.
Identify trends and report them to the Revenue Integrity Coordinator and management.
Identify accounts that did not interface to Meditech and work toward resolving them.
Review and resolve charges applied to incomplete or miscellaneous Meditech accounts.
Review and resolve emergency department accounts with missing evaluation and management levels.
Review and correct observation hourly charges as needed.
Review and resolve room-and-board discrepancies.
Enter miscellaneous and send-out laboratory charges as needed.
Review late charges and report trends to the Revenue Integrity Coordinator.
Conduct an initial review of payer correspondence to identify whether an audit concerns Patient Accounts, clinical areas, or HIM coding.
Promptly document payer correspondence regarding bill or service reviews in Meditech.
Enter information promptly and accurately on the shared spreadsheet and forward correspondence to the responsible party.
Coordinate submission of appeals for audit disputes with team members.
Maintain the appeals spreadsheet, update case statuses, and follow up as needed to resolve submitted-document issues.
Submit appeal statistics to management monthly.
Assist patients with estimates for services as requested.
Assist with large-scale account corrections in conjunction with the Revenue Integrity Coordinator and Corporate Compliance.
Assist with research and education regarding medical policies as needed for denials.
Perform other duties as assigned.