Revenue Integrity Specialist

Memorial Healthcare Owosso , MI 48867

Posted 2 weeks ago

JOB SUMMARY Under general supervision of the Manager, Revenue Integrity is responsible for identifying payment variances and assist with payer enrollment. #Analyze contracts to determine the nature of the variance.# Appeal claims as needed for underpayments and or payment reconsideration.# Monitor appealed accounts through to payment/resolution. Document and communicate underpayment findings throughout the organization and based on findings participate in process improvement. Perform demographic verifications in CAQH with various payers as needed. Complete enrollment, revalidation and demographic updates via CMS 855 form and Champs system.# Maintain provider information files. Strive for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience.# Recognizes and demonstrates understanding of patient and family centered care. PRIMARY JOB RESPONSIBILITIES Use Contract management system to identify and quantify variances between actual and expected insurance payments for the facility and professional services. Appeal accounts as needed for under payments and follow-up on the appeals. Track appeals/recoveries of underpayments and provide monthly report. Performs contract review/analysis to identify root cause of payment variances.# Has strong knowledge of Managed Care contract terms. Has good research and analytical skills. Responsible for documenting and communicating findings within and across key departments (Revenue Integrity, PFS, Finance, IT) Attend payer meetings as needed Assist in the on-going validation and integrity of the Contract Management system#s data and contract set up. Communicate payer/billing concerns to the billing manager and billing staff. Works collaboratively with revenue cycle leaders to implement best practices and improve overall revenue cycle performance. Communicate payer/billing concerns to PFS leadership staff. Keep updated on billing and reimbursement changes for various payers. Must be able to work effectively with others and complete tasks within specified deadlines. Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior. DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES Performs other duties as assigned. JOB SPECIFICATIONS EDUCATION Associates Degree preferred or in lieu of degree 5+ years of relevant experience required. Certification of Certified Revenue cycle representative (HFMA), and or certification of medical billing/office administration preferred. EXPERIENCE Two (2) to five (5) years# experience with professional and or facility insurance billing required. Ability to prioritize workload; demonstrated organizational and problem solving skills. Ability to work independently. Knowledge of various health insurance payment structures, DRG, APC, per diem etc. preferred. Working knowledge of Hospital billing systems and Practice management systems preferred. Demonstrate proficiency with Microsoft Word, and advanced level experience in Microsoft Excel is required. ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS Able to travel independently throughout all Memorial Healthcare facilities. Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC). ESSENTIAL TECHNICAL ABILITIES Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare. ESSENTIAL MENTAL ABILITIES Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws. ESSENTIAL SENSORY REQUIREMENTS Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals. Able to hear for work-related purposes. INTERPERSONAL SKILLS Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication. Required to remain calm when adversity is encountered. Open, honest, and tactful communication skills. Ability to work as a team member in all activities. Positive, cooperative and motivated attitude.

JOB SUMMARY

Under general supervision of the Manager, Revenue Integrity is responsible for identifying payment variances and assist with payer enrollment. Analyze contracts to determine the nature of the variance. Appeal claims as needed for underpayments and or payment reconsideration. Monitor appealed accounts through to payment/resolution. Document and communicate underpayment findings throughout the organization and based on findings participate in process improvement. Perform demographic verifications in CAQH with various payers as needed. Complete enrollment, revalidation and demographic updates via CMS 855 form and Champs system. Maintain provider information files. Strive for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

PRIMARY JOB RESPONSIBILITIES

  • Use Contract management system to identify and quantify variances between actual and expected insurance payments for the facility and professional services.

  • Appeal accounts as needed for under payments and follow-up on the appeals.

  • Track appeals/recoveries of underpayments and provide monthly report.

  • Performs contract review/analysis to identify root cause of payment variances. Has strong knowledge of Managed Care contract terms. Has good research and analytical skills.

  • Responsible for documenting and communicating findings within and across key departments (Revenue Integrity, PFS, Finance, IT)

  • Attend payer meetings as needed

  • Assist in the on-going validation and integrity of the Contract Management system's data and contract set up.

  • Communicate payer/billing concerns to the billing manager and billing staff.

  • Works collaboratively with revenue cycle leaders to implement best practices and improve overall revenue cycle performance.

  • Communicate payer/billing concerns to PFS leadership staff. Keep updated on billing and reimbursement changes for various payers.

  • Must be able to work effectively with others and complete tasks within specified deadlines.

  • Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.

DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES

  • Performs other duties as assigned.

JOB SPECIFICATIONS

EDUCATION

  • Associates Degree preferred or in lieu of degree 5+ years of relevant experience required.

  • Certification of Certified Revenue cycle representative (HFMA), and or certification of medical billing/office administration preferred.

EXPERIENCE

  • Two (2) to five (5) years' experience with professional and or facility insurance billing required.

  • Ability to prioritize workload; demonstrated organizational and problem solving skills. Ability to work independently.

  • Knowledge of various health insurance payment structures, DRG, APC, per diem etc. preferred.

  • Working knowledge of Hospital billing systems and Practice management systems preferred.

  • Demonstrate proficiency with Microsoft Word, and advanced level experience in Microsoft Excel is required.

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

  • Able to travel independently throughout all Memorial Healthcare facilities.

  • Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).

ESSENTIAL TECHNICAL ABILITIES

  • Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.

ESSENTIAL MENTAL ABILITIES

  • Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.

  • Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.

ESSENTIAL SENSORY REQUIREMENTS

  • Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.

  • Able to hear for work-related purposes.

INTERPERSONAL SKILLS

  • Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.

  • Required to remain calm when adversity is encountered.

  • Open, honest, and tactful communication skills.

  • Ability to work as a team member in all activities.

  • Positive, cooperative and motivated attitude.

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Revenue Integrity Specialist

Memorial Healthcare