Revenue Integrity Specialist

At St. Tammany Health System, delivering world-class healthcare close to home is our goal. That means we are committed to attracting and retaining the very best professionals for every position in our health system.

We believe the pristine beauty of St. Tammany Parish adds to our attractive compensation package. The health system is nestled in the heart of Covington on the north shore of Lake Pontchartrain. It is a peaceful, scenic, community-oriented area with an abundance of amenities to suit every taste.

JOB DESCRIPTION AND POSITION REQUIREMENTS

Scheduled Weekly Hours: 40

This position can be an in-office position or a remote/hybrid position (3 days onsite/2 days remote).

Work Shift: (Monday

• Friday) 8:00a

• 4:30p

EDUCATION, EXPERIENCE, AND TRAINING QUALIFICATIONS:

• Bachelor's degree in Business Administration, Healthcare Administration, or closely related field, OR minimum 3 years hospital experience

• Experience in hospital revenue cycle preferred

LICENSURE/CERTIFICATIONS: Nursing licensure, medical coding certification, or auditing certification preferred

OTHER SKILLS AND ABILITIES QUALIFICATIONS:

• Possesses a broad knowledge of the provider side of the healthcare industry with an understanding of ICD10, DRG, CPT4 codes, and UB-04 data elements

• Solid computer and system skills including a working knowledge of Microsoft Office products with experience in MS Excel

• Excellent written and verbal communication skills demonstrating the ability to communicate effectively and courteously

• Strong analytical/critical thinking and presentation skills

• Ability to establish relationships with internal customers and managed care entities

• Ability to work cooperatively with others and have a positive, willing attitude

• Experience with standard concepts, practices, and procedures within healthcare accounts receivables

• Ability to focus on detail and multi-task

• Self-motivated with the ability to work in a dynamic, fast-paced environment

• Excellent organizational skills and maintains a professional and neat work environment

J0B SPECIFIC

1. Works closely with Patient Financial Services in researching post-billing denials

2. Performs and submits Medicaid retro reviews for approval of inpatient stays 3) Audits and adjusts claims for non-covered charges as needed

3. Performs defense audits and approves adjustments as needed

4. Advises department leadership on coding and billing issues to ensure all charges and medical documentation are appropriate and complete

5. Maintains the Charge Description Master (CDM) to ensure accurate charge capture

6. Acts a liaison between STHS and Ochsner Health for all CDM-related additions, updates, and/or changes

7. Maintains the accuracy of CDM line-item services for the hospital clinics by ensuring correct assignment of CPT/HCPCS and revenue codes in compliance with regulatory agencies

8. Establishes and coordinates new charges and CDM process improvements 10) Works in conjunction with department leadership in optimizing revenue opportunities as well as coordinating any necessary department education needed following any CDM or process related changes

9. Works in conjunction with internal auditing to ensure billing compliance and revenue optimization

10. Works with issues related to charge capture, chargemaster maintenance, and charge reconciliation

11. Analyzes and monitors all reimbursement issues as they relate to managed care contracts as well as governmental programs

12. Assists in identifying and recovering underpayments by managed care companies

13. Ensures compliance with all financial terms of provider contacts, including payment rates, denials, etc.

14. Identifies opportunities by evaluating and researching provider trends

15. Works in conjunction with hospital Finance to ensure accurate reimbursement modeling

16. Works in conjunction with all Surgery departments, Cath Lab, Endoscopy, Schedulers, Pre-Access, HIM, and Utilization Management to ensure timely submission of outpatient surgical reauthorizations

17. Provides reauthorization follow-up and oversees the process to completion 20) Performs all other duties as assigned

ADDITIONAL FUNCTIONS

1. Prioritizes work to ensure proper distribution of assignments

2. Performs all duties in compliance with Federal, State, and other hospital regulatory agencies including, but not limited to CMS, HIPAA, and JCAHO. Reports non-compliance to manager immediately upon identification

3. Responds to inquiries and requests in a timely manner

4. Attends in-service classes and seminars to maintain competency in all areas of job and regulatory compliance

5. Identifies learning needs and seeks assistance in skill development

6. Completes all education in HealthStream as assigned

7. Demonstrates actions consistent with St. Tammany Health System's C.A.R.E.S. standards as duties are performed daily

EMPLOYMENT

Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision and values. Please take time to review those expectations, which can be found by clicking here, before applying for employment. If you feel you are unable to demonstrate those characteristics, we respectfully request that you do not proceed with the application process.

EQUAL OPPORTUNITY EMPLOYER

St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.