Revenue Integrity Audit Specialist

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

MO-SSM Health St. Mary's Hospital - St. Louis

Worker Type:

Regular

Job Highlights:

Supports Diagnostic Imaging as a subject matter expert for achieving operational efficiency, compliance, and exceptional patient care. Serves as a liaison between and resource for clinical and Revenue/Financial departments with strong understanding of both components. Ensures best practices are utilized throughout the St. Louis Imaging Network.

Job Summary:

Supports assigned department(s) as a subject matter expert for achieving operational efficiency, compliance, and exceptional patient care. Serves as a liaison between and resource for clinical and Revenue/Financial departments with strong understanding of both components.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Serves as a resource and subject matter expert to the for department workflows, documentation, coding, charging, and software applications.
• Manages all work queues using subject matter expertise to investigate/correct errors to aid in timely and accurate claims.
• Investigates clinical & technical report deficiencies to ensure all reports are completed timely to prevent delays in patient care.
• Ensures accuracy & completeness of daily charges/CPT code assignment; applying modifiers as needed & ensure supporting documentation is present.
• Work one-on-one with staff and Physicians to ensure documentation requirements are being met according to coding & billing guidelines.
• Create and generate reports utilizing multiple reporting tools across multiple databases to support leadership on strategic initiatives.
• Completes audit/project evaluations and reviews selected records to determine accuracy of orders, charges, and documentation. Shares findings with leadership and collaborates to achieve departmental goals, objectives, and best practice.  
• Maintains current knowledge of Charge Description Master (CDM), Charge Preference List (CPL) and Flowsheet Charging to provide support for assigned health ministry to produce a bill/claim by attending coding conferences, workshops, and self-guided learning.
• Collaborates with management and subject matter experts to understand the desired performance, assess learning needs, and develops appropriate training solutions. Provides ongoing training relative to charge accuracy & department specific workflows that impact coding/billing compliance and delivery of timely patient results.
• Performs other duties as assigned.

EDUCATION

• Associate's degree

EXPERIENCE

• Two years of experience in assigned department(s) or coding experience

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 climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 

• None

Department:

4218000130 Imaging Admin

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 

• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

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SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.