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Revenue Integrity Specialist

Job in Appleton - Outagamie County - WI Wisconsin - USA , 54914
Company: ThedaCare
Contract position
Listed on 2021-02-28
Job specializations:
  • Healthcare
  • Administrative/Clerical
Job Description & How to Apply Below
Why ThedaCare?

ThedaCare's reputation for providing outstanding, individualized care is directly attributed to the unrelenting passion for safety and quality demonstrated by our team members. We advocate for each patient by providing timely information and convenient access that empower them to make confident decisions about their health. Our combined expertise allow us to better predict and prevent disease and support a more proactive approach to care, making a critical difference in the lives of our patients and their families.

A career with ThedaCare means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a healthcare system that is changing the face of care and wellbeing in our community, we encourage you to explore a future with ThedaCare.

Job Description Summary :

Job Description:

KEY ACCOUNTABILITIES: 1. Audits daily work queues and randomly selected patient accounts for accuracy and compliance of charges, payments, and coding entered. Identifies charge adjustments, initiates follow-up work, and/or corrects charge defects. 2. Works in collaboration with clinical, coding, billing, and reimbursement coordinators to troubleshoot and resolve discrepancies. 3. Analyzes and compiles trends for quarterly revenue integrity audits and presents to appropriate review committees. 4. Educates clinical team members on the application of charge policies to ensure compliance with established guidelines and government or other third party payers. 5. Works with clinical departments to address external audit recommendations including Recovery Audit Contractor (RAC) audits on identified revenue compliance gaps to ensure proper billing. 6. Conducts review of revenue cycle reporting for new departments or services to ensure that charges are captured accurately and revenue is generated and reported appropriately. 7. Monitors third party correspondence for Code Correct Initiative (CCI), Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), Medical Unnecessary Edits (MUE), Center for Medicare and Medicaid Services (CMS) alerts, Office of Inspector General (OIG) work plans, third party payer bulletins, etc.), and notifies affected departments of changes. Performs ongoing analysis and interpretation of regulations as they apply to third party reimbursement and compliance. Identifies and validates charges are billed appropriately based on changes. 8. Assists the Charge Description Master (CDM) team in the development of formal charge policies created for clinical departments along with the periodic review of charge policies to ensure they are updated for payer specific changes. QUALIFICATIONS: • High school diploma or GED • Five years of experience in health care compliance or auditing • Three years of coding experience, CPC preferred. PHYSICAL DEMANDS: • Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance • Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties WORK ENVIRONMENT: • Use of computers throughout the work day • Frequent use of keyboard with repetitive motion of hands, wrists, and fingers • Normally works in climate controlled office environment • Frequent sitting with movement throughout office space

Scheduled Weekly Hours:


Scheduled FTE:



ThedaCare Corporate Office - Neenah,Wisconsin

Overtime Exempt:

Position Requirements
Less than 1 Year work experience
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