Revenue Integrity Claims Specialist - Revenue Integrity

Revenue Integrity Claims Specialist - Revenue Integrity - Days - FT Job Description

The Revenue Integrity Claims Specialist is responsible for coordinating claim edit and rejection review with reference to billing compliance guidelines across all payors. The Claims Specialist trends and facilitates the follow up of billing issues and denials with the revenue staff to decrease delays in claim submission and promote efficiency and revenue integrity. The Claims Specialist resolves claim errors, edits, and other holds and identifies trends and opportunities for improvement.

The Claims Specialist develops and delivers education to staff regarding workflows, compliance guidelines and regulatory requirements.

Coordinates claims correction to promote reimbursement

• Reviews rejected claims to identify errors and necessary action
• Facilitates claim correction with revenue staff and provides instructions on addressing deficiencies
• Follows up on correction status to ensure timely resolution
• Documents errors and reports findings to the appropriate team member

Investigates and resolves claim errors through utilization of resources

• Gathers missing or incomplete claim information
• Collaborates with external resources to resolve rejections
• References policies and guidelines to ensure payor compliance
• Performs claims corrections and edits as appropriate

Evaluates rejection causes and identifies opportunities for efficiency and improvement

• Performs analysis of denied claims to identify trends impacting revenue collection
• Assesses workflow processes and recommends changes to prevent rejections

Educates team members in developing and maintaining initiatives geared towards quality improvement

• Reviews educational needs and develops training related to claims processes
• Through ongoing training and requirements, ensures compliance with organizational standards and regulatory requirements

Associates degree or High School Diploma/ Equivalent with required experience.

Four years of experience (with Associates degree) or six years of experience (with no degree) in a revenue cycle role including billing and follow up.

Biloxi Annex, 220 Popps Ferry Road