Compliance Specialist - St George Business Office

R1 Revenue Cycle Management Orem , UT 84057

Posted 2 months ago

Shift : Monday - Friday, 8:00AM 4:30PM

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is a publicly-traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients and each other. With our proven and scalable operating model, we complement a healthcare organization's infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Compliance Specialist will be responsible for the correction, rebilling, and collection of audited patient accounts as part of the Claims Resolution and Improvement Team. Government payers require that overpayments be returned within 60 days from the date of the identified overpayment. This position is responsible for identifying overpayments and submitting corrected claims or refunds to the appropriate payer to ensure that Intermountain Healthcare meets regulation requirements.

Responsibilities:

  • Ordering and correcting audited claims to payers within a limited time frame.

  • Collecting on outstanding accounts to ensure claims have been reprocessed by payers in a timely manner.

  • Working with facility departments or Ambulatory Coding and Reimbursement and providers to resolve coding errors.

  • Providing research, using bills and medical records, to validate charges.

  • Acting as a subject matter expert and resource to others by demonstrating an understanding of government regulations and requirements for overpaid patient account while demonstrating an understanding of charge related policies, procedures, and guidelines.

  • Creating daily reports to improve payment results and ensuring that corrected claims are processed by the payer within appropriate timeframes.

  • May complete the Medicare Quarterly report for assigned regions.

  • May participate in corporate audits, providing input for the development of audit objectives, scopes, and procedures.

  • Collaborating with team members to interpret and analyze audit results to develop corrective action plans.

  • Acting with minimal supervision to prepare reports for presentation to management and Intermountain leaders.

Required Qualifications:

  • Three years customer service experience.

  • One year of experience working in the PSR / Account Resolution department in a role requiring the demonstration of proficiency with policies and procedures, and competence in a wide range of department job functions and responsibilities.

  • Experience in a role requiring billing or collection experience within the last three years.

  • Experience working effectively in time sensitive situations, multi-tasking and making prompt, responsible decisions.

  • Experience in a role requiring strong interpersonal and problem solving skills, and the demonstrated ability to work independently and under pressure with minimal supervision and excellent organizational skills.

  • One year of experience using word processing, spreadsheet, database, internet and e-mail, and scheduling applications with demonstrated typing proficiency.

  • Demonstrated ability to work in a high volume fast paced work environment and meet deadlines.

  • Demonstrated ability to embrace and manage change in a positive and supportive manner.

  • Demonstrated ability to communicate and problem solve issues professionally and effectively with individuals at all levels of the organization.

  • Demonstrated ability to think independently, evaluate situations, and take appropriate action to resolve with minimal direction

Desired Qualifications:

  • Medical terminology, admitting, medical billing, or insurance verification experience.

  • Experience leading or coordinating the work of others.

  • One or more years of Medicare billing and collection experience.

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovative and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: R1RCM.com.


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Compliance Specialist - St George Business Office

R1 Revenue Cycle Management