Revenue Integrity Specialist

Coffee Regional Medical CDouglas, GA, US

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Job Description

Department : Patient Financial Services

Job Title : Revenue Integrity Specialist

Reports to : Revenue Integrity Supervisor

Schedule : Monday – Friday

POSITION SUMMARY

Responsible for analyzing all aspects of denial management including identifying and evaluating payer contract compliance and monitoring denials trends.
User aggregate data and monitors activity trends that can be used to identify opportunities to prevent future unpaid or denied claims.
Ensures that all payer contracts are set up correctly within the contract maintenance software system.
Makes appropriate personnel aware of reimbursement / denial issues in a timely manner.

OVERVIEW

The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the supervisor and the employee participate in the evaluation process.

QUALIFICATIONS

A. Knowledge, Skills and Abilities

Excellent customer service skills.

Reads and understands the English language.

Ability to think critically and analytically with little or no supervision

Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.

Ability to process information and prioritize

Possesses exceptional verbal and written communication skills

Possesses independent work habits, is self-reliant and self-directed

Ability to learn, adapt, and change as required by the job functions

Ability to maintain absolute confidentiality of material and information accessed and reviewed

Basic computer literacy

Ability to move freely, reach, bend, and complete light lifting

Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines

Ability to maintain attendance to meet standard job practices

B. Education

High School diploma required, with some college level courses desirable.

Preferably C.P.A.R. certified, but not required.

C. Licensure Preferred : CCS, CPC, CCA, AAPC, RHIA, RHIT

N / A

D. Experience

E. Interpersonal skills

F. Essential technical / motor skills

G. Essential physical requirements

Light : Exert up to 20 lb. of force occasionally and / or up to 10 lb. of force frequently - greater than 75%

Medium : Exert 20 – 50 lb. of force occasionally and / or up to 15 lb. of force frequently - 1-24%

H. Essential mental requirements

I. Essential sensory requirements

J. Other

Must have good oral and written communications and ability to train personnel.

Must possess analytical and problem-solving skills and the ability to work and communicate effectively with departmental supervisors, directors, and upper management personnel.

Must possess excellent interpersonal skills and high adaptability to a changing environment.

Knowledge of software processes, ability to handle multiple projects simultaneously, training and troubleshooting skills, project management skills, customer service skills, have the ability to work under little supervision.

K. Equipment used

OTHER QUALIFICATIONS

A. Exposure to hazards (body fluid exposure level)

B. Age of Patient Populations Served

JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS

Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.

Job Specific :

o Responsible for verifying accuracy of payments as well as tracking, analyzing and preventing claim denials and underpayments.

o Acts as a resource to Patient Financial Services staff and other departments.

o Responsible for maintaining and updating contract / reimbursement software as needed on a daily basis.

o Makes Supervisor aware of any underpayment or denial trends by payor(s) that conflict with the language of our contract with said payor(s). Provides Supervisor with specific account information for follow-up.

o Reviews and submit appeals as needed for various personnel.

o Communicates effectively using multiple methods to keep staff and other departments informed of billing changes and / or reimbursement issues.

o Acts as an agent for change from traditional practices and pursues positive changes.

o Committed to achieving excellent customer service and operational performance.

o Keeps Supervisor informed on the status of his / her work.

o Attends seminars and workshops related to software systems used in the department and billing policies and procedures.

o Handles requests from staff or management in a prompt and positive manner.

o Communicates all billing regulation changes to appropriate departments / staff as needed.

o Implements and participates in the educational programs for all billing staff.

o Must maintain knowledge base of all the billing and collection areas in order to perform job at a satisfactory level.

o Accepts full ownership of special work and / or project assignments.

o Resubmits claims in accordance with payer guidelines.

o Maintain patient confidentiality of information to assure Patient Rights and the rights of others are protected in accordance to policy and procedure. Release information in accordance with established privacy guidelines.

o Performs duties in an independent manner with minimal direct supervision.

o Can solve day to day problems within scope of practice and make decisions in a timely manner.

o Offers workable ideas, concepts and techniques to improve productivity.

o Willing to attempt new job duties, tasks, etc.

Other Performance standards :

o Maintains regulatory requirements including all state, federal and Joint Commission regulations related to Patient Financial Services and, as appropriate, to the facility.

o Performs any other task as requested by Supervisor or Management in a willing and positive manner.

o Accepts assignment as preceptor for new staff.

o Attends 75% of scheduled meetings as evidence by minutes and / or agenda.

o Operates assigned equipment and performs all procedures in a safe manner as instructed.

o Maintains work area and equipment in condition required by department standards.

o Demonstrates proper body mechanics in all functions.

o Effectively utilizes unit manuals as resources in order to clarify and / or resolve hospital policy issues.

o Participates in annual education programs.

o Wears and / or uses appropriate safety equipment.

o Interacts with all of the above in a considerate, helpful, and courteous manner.

o Fosters mature professional relationships with fellow employees in a courteous, friendly manner as measured by management observation and peer input.

o Conducts all work activities with respect for rights and wishes of patients, visitors, families, and fellow employees.

o Maintains confidentiality of all hospital and patient information at all times.

o Presents neat appearance in proper attire and identification as required by hospital policy.

o Displays a positive attitude that contributes to the overall customer service program in place at the hospital.

o Participates in staff meetings as required

o Supports the hospital's mission, policies, and programs through attendance and participation at committee meetings.

o Demonstrates ability to use the computer system(s).

o Completes work assignments on time / readily accepts assignments as observed by supervisor / director.

o Reports to work on time, is at work as scheduled & attends to personal affairs to avoid conflicts with work, as observed by supervisor / director.

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Revenue Integrity Specialist • Douglas, GA, US