Revenue Integrity Specialist

Job Description

Job Summary:

The revenue cycle specialist is responsible for overseeing and assisting with inpatient and outpatient billing, including professional fees. Interacts with families/responsible parties for questions related to the billing or reimbursement process. Responsible for up-front and previous balance collections as needed and performing job duties in accordance with the policies and mission of Ranken Jordan Pediatric Bridge Hospital.

Duties and Responsibilities:

Assist in managing primary and secondary billings for Inpatient, Outpatient, and Physician Fees. Ensure that both electronic and hard copy claims are sent in a timely, accurate and efficient manner to the appropriate insurance payor.

Assist with review of any credit balances on patient’s account that are over 30 days. Request refunds as needed, ensuring information is posted to the proper patient’s accounts in a timely and accurate manner.

Determine patient’s financial responsibilities as indicated by insurance and accurately document findings in the EMR.

Contact patients prior to date of service to discuss financial obligations and to collect any monies owed, including co-pays, deductibles, co-insurance, and any past-due balances prior to date of service.

Discuss questions and concerns over charges, payments posted, and any insurance questions. Refer patients and families to patient advocate as needed for financial assistance.

Assist in reviewing insurance remits from various websites and received via mail or fax and compare actual reimbursement to expected reimbursement based on services billed. Participate in monthly/quarterly calls with provider representatives to discuss variances identified and paths needed and/or taken for resolution. (10%)

Assist coordination with team members and other departments as needed to conduct follow ups on all unpaid claims that have been billed and remain unpaid 30 days after initial billing. Any reason for non-payment should be documented within the patient record in Cerner and if appropriate, placed on the tracking tool. (10%)

Other duties as assigned, including cross training into other areas of Revenue Cycle operations. (10%)

Qualifications:

Prior experience with payor contracts, reimbursement methodologies, electronic remittances and payment posting required.

Knowledge of ICD-10, Revenue Codes, HCPCS/CPT Codes strongly preferred. Experience working in Cerner preferred.

Computer skills including but not limited to Microsoft Office, Excel, and Word required.

Experience in a hospital business office setting required.

Excellent organizational, time management, and critical thinking skills required. Ability to prioritize multiple tasks and work independently required

Physical Demands:

These include stooping, kneeling, crouching, reaching, grasping, pulling, pushing, standing, carrying, and lifting of light loads (up to 35 lb.).

Full-time