Revenue Integrity Specialist

Overview

Revenue Integrity Specialist at Lifepoint Health®.

• Coordinate, evaluate and measure revenue integrity operations; develop systems to manage medical necessity denials; and develop tracking mechanisms to measure loss leaders and improvements by service line, payer and provider.
• Document and track all RAC and payer audit requests and ensure timelines are met.
• Manage submission of records, respond to denials and appeals requests, and share RAC findings with key members of the organization.
• Coordinate and manage RAC notifications in varying phases of appeal based on feedback.
• Log, notify, and scan all government correspondence; maintain e-requests and ensure appropriate parties are informed.
• Collaborate with departments to develop and document processes that facilitate clean automated billing of hospital claims, including identifying people, processes and technology issues and participating in process improvement rollouts.
• Participate on existing teams and lead project teams as needed.
• Work with Scheduling, Registration, Clinical Departments, Health Information Management and the Business Office to educate staff and assess competency related to the revenue cycle.
• Assist in preparing educational materials and provide education as needed.
• Collaborate with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office personnel to maximize reimbursement through proper charging and coding of patient claims.
• Assist with SOX audits, insurance denial appeals and patient charge concerns as needed.
• Participate in policy and procedure development and ensure compliance within the Revenue Cycle; contribute to issue resolution and process refinement to prevent future issues.
• Stay informed of current healthcare revenue cycle trends and regulatory changes.
• Verify insurance benefits and obtain precertification/authorization as necessary.
• Determine and collect required payments, including co-pays and deductibles, or refer to financial counselors for follow up.
• Perform medical necessity checks when appropriate (if not already done during scheduling or pre-registration).
• Able to provide coverage to other areas of registration when necessary.

• Education:
  
  High school diploma or equivalent required. College education or 2 years experience preferred.
• Knowledgeable with hospital bill processing and insurance practices; HCPCS/CPT/UB04 experience, modifiers, Medicare APCs, and billing regulations required.
• Experience in reimbursement analysis, strong written and verbal communication skills, knowledge of Medical Terminology, strong organizational skills and ability to multi-task.
• Strong computer skills including Excel; ability to interact positively with internal and external customers; good problem-solving and audit communication abilities.
• Must be willing to learn new tasks and be a self-starter; able to perform work duties with minimal supervision.
• Two years of hospital revenue cycle experience preferred; physician billing/reimbursement experience helpful.
• Demonstrated expertise in patient accounting management and billing systems; experience with coding (CPT, diagnosis, revenue and insurance codes); working knowledge of Medicare IP PPS, OPPS, Medicaid and commercial billing guidelines; strong understanding of hospital charging and rate structure.
• Requires prolonged sitting for calls; routine standing, bending, stooping; lifting up to 25 pounds; full range of motion and effective communication skills.

• Document and track RAC and payer audit requests; maintain RAC and Arthur Databases to ensure timelines are met.
• Manage submission of records, respond to denials and appeals; share RAC findings with key stakeholders.
• Coordinate RAC notifications in varying appeal phases based on feedback.
• Log and scan all government correspondence; inform appropriate parties; maintain e-requests.
• Collaborate with departments to develop processes that facilitate clean automated billing of hospital claims; identify issues and participate in process improvement rollouts.
• Lead and participate in project teams as needed; educate staff across departments on revenue cycle…