Revenue Integrity Analyst

Ortho Northeast is looking for an experienced Revenue Integrity Analyst, who is either CPC or AHIMA certified.

• Actively monitor claims to identify potential payment or informational problems, with emphasis on payer policies, denial management and AR reduction. Correct, approve, and re-file claims. Correct or initiate correction of errors within the organizational system, per department protocol. Follow up with payers to resolve denials in a timely manner.
• Conduct peer auditing.
• Determine, document, and post adjustments to patient accounts in accordance with organizational policies and procedures.
• Process incoming correspondence as well as providing necessary documentation on pended claims to facilitate claim processing.
• Identify payer trends.
• Field insurance calls/inquires (i.e. insurance questions regarding patient accounts from patients and/or ONE staff.)
• Monitor payer websites, policy updates/changes, newsletters, publications, list serves, bulletins for coding and billing updates that impact ONE, sharing when applicable.
• Offer solutions and workflow efficiency alternatives for best outcomes.
• Provide education within team and organization.

Experience and Expected Skills:

• Minimum of 12 months of orthopedic experience surgical coding background. Preferably in a physician office setting.
• Ability to read and interpret an Explanation of Benefits.
• Operate patient accounting system after proper instruction to research problems, identify solutions, and resolve conflicts.
• Skilled in decision making and problem solving.
• Skilled in education of others within the organization.
• Communicate effectively, clearly, and concisely with management, physicians, staff and venders.
• Understand and utilize audits, education policies/procedures related to billing and coding.
• Typing and computer keyboarding knowledge.
• Word, Excel, Outlook knowledge is required.
• Maintain credentials, including appropriate orthopaedic related continuing education units (CEU), approved by Supervisor, required for maintenance of certification. CEUs will be reported and monitored as necessary.

Physical and Mental Demands:

• Requires frequent finger/hand/wrist movements and upper extremity dexterity and coordination to perform computer functions, process paperwork, and telephone use.
• Requires constant sitting or standing while using a stand up work station, to perform computer data entry, process paperwork, and telephone use.
• Requires mental alertness, follow-through, recall, and exacting attention to detail for accurately completing review of billing, auditing, process paperwork, correspond with customers both in written and verbal form.
• Requires ability to exercise independent judgment and make appropriate decisions.
• Requires ability to read, understand, and disseminate regulatory requirements associated with accurate and efficient billing practices.
• Requires ability to maintain positive attitude and tactful communication while working under pressure with time constraints, hectic pace, background noise, and frequent interruptions.

Onsite training and onboarding. With full time remote work beginning within 2 weeks of start date. Ability to come to office as needed is required. Must live in the greater Fort Wayne area.

Schedule:

• Monday to Friday

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• 401(k)
• Profit Sharing
• Paid time off
• Short Term Disability
• Long Term Disability
• Employee assistance program
• Life insurance
• Wellness reimbursement

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Have you ever worked at ONE before?
• Were you referred by a current ONE staff member?
• Are you CPC or AHIMA certified?

Work Location: In person