The Revenue Integrity Specialist will be responsible for the daily operational processes of the Onslow Hospital Revenue Integrity Program. This position will assistant in ensuring the accuracy and integrity of the charge description master seeking a charge master that reflects the Patient Friendly Billing Initiative recommended by HFMA. This position will perform revenue audits to ensure revenue integrity as related to adherence to federal and state regulations, policies of external payers, coding rules, and guidelines. The Revenue Integrity Specialist is responsible for the management of various operational charge capture functions. Responsibilities of this position will include peer training and mentoring, assisting clinical leadership and staff with charge reconciliation, identifying denial, missed charge trends, identifying, and eliminating revenue leakage, charge reporting, and charge troubleshooting. This position is responsible for peer mentoring and leadership, educating revenue center departments on best practices to review and reconcile their daily charge capture processes, as well as improvement on timely charging and eliminating revenue leakage. This individual will develop, produce, validate, and distribute standard charge-related reports and ad-hoc reports as needed. This individual will work closely with a vast array of clinical, financial, and IT leadership and staff of the organization to ensure that coding, charging, charge reporting, and reconciliation processes function smoothly. Proper charge capture is critical to achieving fair billing practices, meeting third part billing requirements, receiving appropriate reimbursement for services rendered, reaching revenue targets, and enhancing reporting capabilities. This position will actively conduct reviews for appeals from payor denials. This individual will assist in ensuring that denied and/or rejected claims are accurately worked and appealed to obtain maximum reimbursement and minimize recoupment. This position will facilitate collaboration between the Utilization Review, HIM Staff, Medical Staff, Physician Advisor and all applicable parties to ensure that applicable rejections and denials are thoroughly reviewed and that an appeal letter, if warranted is well written and submitted in a timely manner.
High school diploma required. Associate's or Bachelor’s degree in Healthcare Administration, Finance, or Nursing preferred. Two years of experience in charge capture, coding, or hospital business office may be considered in lieu of the degree in addition to the experience below.
Two (2) years of analysis in financial, reimbursement modeling or healthcare data or managed care negotiations with a healthcare organization, provider group, or health plan/payer preferred. Experience in billing or coding in a healthcare organization required. Data analysis and reporting Billing/Collections, Insurance Claims, Microsoft Office, good communication skills are essential.
