Revenue Integrity Specialist

Silver Cross Hospital is an extraordinary place to work. We're known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve...and for each other. Come join us! It's the way you want to be treated.

Position Summary: Works in conjunction with the Revenue Integrity Coordinator to ensure charging issues are resolved correctly and promptly. Reviews all charging reports to resolve the discrepancy timely including rejections from Cerner to Meditech, Meditech accounts with charges but not completely registered, late charges for accuracy, ER accounts missing E&M charges, Room and Board discrepancies, Observation charging, etc. Identifies Payer requests pertaining to bill accuracy, length of stay, level of care, medical necessity, and coding. Maintains proper documentation for audits received from carriers and works with Team Members to submit the needed information timely when appealing audits, DRG downgrades, medical necessity and level or care. Create and maintain reports for management regarding the number of appeals received, completed, approved, and upheld. Assists with large-scale account corrections in tandem with the Revenue Integrity Coordinator and Corporate Compliance. Assists with the research and with education regarding medical policies as needed for denials.

Essential Duties and Responsibilities:

• Reviews and resolves charge rejections from Cerner to Meditech daily.
• Identifies trends to report to Revenue Integrity Coordinator and Management
• Identifies and works toward resolving accounts that did not interface to Meditech
• Reviews and resolves charges applied to incomplete or miscellaneous accounts in Meditech.
• Reviews and resolved ER accounts with missing E&M levels
• Reviews and corrects needed observation hourly charges
• Reviews and resolves Room and Board discrepancies.
• Enters miscellaneous and send out lab charges as needed.
• Review late charges and report back trends to Coordinator.
• Complete initial review of correspondence from Payers to determine if audit is for Patient Accounts/Clinical areas or HIM for coding.
• Promptly document Meditech regarding Payer correspondence regarding bill/service review
• Promptly and properly enter information on shared spreadsheet and forward correspondence to responsible party.
• Coordinate the submission of appeals for the audit disputes with Team members.
• Maintain spreadsheet with updates regarding Appeals and complete follow up as needed for resolution of documents submitted.
• Submit appeal statistics to Management monthly
• Assist patients with estimates for services as requested.
• Other duties as assigned

Required Qualifications:

Must demonstrate tact and diplomacy in interpersonal interactions, in addition to maintaining composure in confrontational situations. Requires strong oral and written communication skills, analytical, problem resolution skills, and customer service skills. Ability to adhere to work plans and manage resources to bring about the successful completion of daily workflow and goals. Maintains current knowledge of relevant regulatory requirements as they relate to industry and payer regulations, policies, and procedures. Strong knowledge of Excel.

Education and Training:

• Bachelor's degree in Business, Healthcare, Finance/Accounting or related field preferred.

Work Shift Details:
Days - First Shift, Days, Monday through Friday

Department:
PATIENT ACCOUNTS