Revenue Integrity Specialist

It's more than a career, it's a calling.

MO-REMOTE

Worker Type:

Regular

Job Highlights:

Schedule: 8 hour shift with start times between 6:30am and 8:30am, Monday - Friday

Qualifications: Ideal candidate has experience with healthcare revenue cycle, billing and coding, Epic, and has a strong attention to detail.

The Revenue Integrity Specialist will contribute in the following areas:

• Assists in daily resolution of work queue/edits that are holding patient claims from billing by reviewing applicable documentation
• Identifies, reports, with escalation as needed, and participates in the resolution of any potential or actual revenue/charge related issue
• Identifies areas of common practice and implements opportunities for standardization
• Monitors EPIC Revenue Integrity Dashboard(s) in collaboration with ministry liaisons to manage and report out weekly for leadership/colleagues
• Responds to departmental charging inquiries
• Provides support for assigned ministries in collaboration with Revenue Integrity Analysts
• Works with coding and other clinical departments to identify/fix errors based on ICD/CPT coding guidelines and National Correct Coding Initiative (NCCI) edits
• Contributes to improvement initiatives as directed by department leaders, focusing on WQ accuracy of rules, naming conventions and assignments, and KPIs for performance as assigned

Remote work: This position may be eligible for remote work in accordance with SSM policies. Note that remote work is not permissible in some states; Human Resources should be consulted for additional information and guidance. 

*Candidates must reside in MO, IL, OK, or WI

Job Summary:

Contributes and supports revenue cycle’s mission for achieving operational efficiency, regulatory compliance and proper reimbursement entitlement. Improves revenue with a basic understanding of the revenue cycle. Analyzes account edits prior to claim submission through monitoring, identifying, and correcting errors. Serves as a resource for health ministry coworkers, clinical/non-clinical, and coding.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Assists in daily resolution of work que/edits that are holding patient claims from billing by reviewing applicable documentation.
• Identifies, reports, with escalation as needed, and participates in the resolution of any potential or actual revenue/charge related issues.
• Identifies areas of common practice and implements opportunities for standardization.
• Monitors EPIC Revenue Integrity Dashboard(s) in collaboration with ministry liaisons to manage and report out weekly for leadership/colleagues.
• Responds to departmental charging inquiries.
• Provides support for assigned ministries in collaboration with RI Audit team.
• Works with coding and other clinical departments to identify/fix errors based on ICD/CPT coding guidelines and National Correct Coding Initiative (NCCI) edits.
• Contributes to improvement initiatives as directed by department leaders, focusing on WQ accuracy of rules, naming conventions and assignments, and KPIs for performance board as assigned.
• Performs other duties as assigned.

EDUCATION

• Associate’s degree or equivalent combination of education and experience

EXPERIENCE

• One year experience within a hospital organization or physician practice environment

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare cl