Revenue Integrity Specialist

Job Description

Job Description

WE ARE GATEWAY REGIONAL MEDICAL CENTER!

Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

• Essential / stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
• Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance (bonuses only apply for Full Time).
• Comprehensive Employee Benefits : Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

Job Objective :

The Revenue Integrity Specialist reports directly to the Director of Revenue Cycle with a dotted-line responsibility to the Director, of Medical Records.

Responsibilities include but are not limited to ensuring facility-wide charge capture happens daily, analyzing medical and financial data as it relates to the audit of patient charges in comparison to medical record documentation and assists with monitoring the facility Chargemaster for accuracy and compliance with applicable regulations and guidelines.

Primary Duties and Responsibilities :

Charge Capture

Review observation patient records daily and enter observation hour charges, carving out the hours when patients are not actively in the patient room receiving observation services.

For example, carve outs would include patient left the room for other procedures or imaging services, etc.

• Review daily revenue and usage reports by department to validate charges are dropping as expected, Urgent Care, Emergency Department, Inpatient, etc.
• Ensures all documents requiring Provider signatures are complete.
• Acts as Hospital representative for internal and external third-party defense audits.
• Responsible for data input of late charges and credits as determined by audit findings to the Patient Accounting system to reflect audit results
• Reviews and evaluates documentation practices and procedures and makes recommendations for improved efficiency and accuracy
• Conducts in-depth special studies as requested, sometimes working closely with department directors.
• Develops and maintains systems for recording audit activities, outcomes, and financial impact of findings

Knowledge

Knowledge of healthcare industry accepted billing and audit practices

Knowledge of the Charge Description Master and how it relates to accurate billing processes

Knowledge of common procedural coding and medical terminology

Experience

Minimum 2-years experience working with clinical staff and documentation in an acute care setting

Will consider previous experience as an Auditor in a healthcare related field