Revenue Integrity Specialist I

Job Description:

Baptist Health is looking for a Revenue Integrity Specialist to join our team. This is a remote position that requires residency in KY or IN

Research denials or audits from all commercial and governmental payors. Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains predeterminations, prior authorizations, and retro authorizations when required by 
payor. Responds to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines. Recovery efforts include but are not limited to written letter, email, web site, and telephonic 
communication. Actively seeks opportunities to positively impact Revenue Cycle workflows and metrics, utilizing experience to identify process improvement needs, design and implement best practices. Works independently with other departments / physician offices to adapt best practices to changing needs within the local or broader healthcare environment. Escalates issues to Manager and Director when a department is not responsive to suggestions for preventing revenue loss.

Essential Duties:

• Reviews all denials on accounts and takes all possible appropriate follow-up action to secure full reimbursement from payor. Reaches out to Revenue Integrity clinical staff, other departments and physician offices to request assistance (additional documentation, coding review, letter of medical necessity, etc.) when necessary to successfully appeal an account. Follows up on account until full reimbursement recovered or all reasonable appeal options are exhausted.

• Fulfills all government audit record requests within mandated timeframes; consults with clinical / Health Information Management staff as necessary to supplement records to appropriately support compliance of medical services rendered. Provides feedback regarding compliance concerns to Supervisor and Manager as well as local compliance leadership.

• Tracks all denial and government audit follow-up activity and results in appropriate systems and updates systems in a timely manner in regard to action taken or result received.

• Proactively organizes workflow according to priorities assigned by management. Utilizes software tools, work lists or queues, and other tools to balance appropriate intervention with account reimbursement value and deadlines.

• Identifies opportunities to prevent revenue loss, both in a reactive response to denials and government audits as well as in a proactive response to changes in payor and governmental guidelines. Communicates trends and opportunities to Supervisor and Manager.

• Maintains tracking of denial / government audit patterns as directed by management.

• Utilizes department best practices to recover or defend reimbursement in the most efficacious manner possible. Constantly seeks more efficient methods for completing tasks; offers suggestions for process improvement to Supervisor and Manager.

Minimum Education, Training and Experience Required

• Bachelor’s Degree in a related field, Practical Nurse License, or Coding Certification. Five years of healthcare experience including two years in a revenue cycle related area such as registration, patient financial services, or managed care.

• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal resolution processes; and managed care contracts. Individuals working with government audits must have a keen understanding of all audit response requirements and timelines.

If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!

Baptist Health is an Equal Employment Opportunity employer.