Revenue Integrity Specialist

At Starr Regional - Health and Rehab, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In this role, you'll support those interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What We Offer

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

About the Role

The Revenue Integrity Specialist coordinates, evaluates, and measures revenue integrity operations; develops systems to manage medical necessity denials; and creates tracking mechanisms to measure loss leaders and improvements by service line, payer, and provider.

Reports to: Patient Access Supervisor

Responsibilities

• Document and track all RAC and Payer audit requests, including maintaining the RAC and Arthur Databases to ensure that all timelines are met.
• Manage the submission of records and respond to denials and appeals requests.
• Share RAC findings with key members of the organization.
• Coordinate and manage numerous RAC notifications in varying phases of appeal based on feedback.
• Log, notify, and scan all Government correspondence coming into the facility, ensuring that all appropriate parties are informed.
• Maintain e-requests.
• Work with departments that impact the hospital's ability to develop and document processes which facilitate clean automated billing of hospital claims. This includes identification of people, process, and technology issues, development of appropriate solutions, participation in roll-out of the process improvement solutions, and ongoing monitoring.
• Participate on existing teams and initiate and lead project teams as needed.
• Work with Scheduling, Registration, Clinical Departments, Health Information Management, and the Business Office to ensure all staff that impact the revenue cycle receive needed education and competency assessment.
• Assist in the preparation of educational material and provide education as needed.
• Work directly with clinical operating departments, Managed Care & Reimbursement, Supply Chain, and business office personnel to ensure the hospital receives all reimbursement to which it is entitled through appropriate charging and coding of patient claims.
• Assist with SOX audits, insurance denial appeals, and patient charge concerns/complaints as needed.
• Participate in the development of policies and procedures and ensure compliance within the Revenue Cycle.
• Participate and collaborate in resolution of Revenue Cycle issues and refinement of the process to prevent future issues.
• Keep informed of current healthcare-revenue cycle trends and regulatory changes.
• Verify insurance benefits and obtain precertification/authorization as necessary.
• Determine and accept required payments, including co-pays and deductibles, or refer to financial counselors for follow-up.
• Perform medical necessity check, when appropriate (if not already done so in scheduling or pre-registration process).
• Able to provide coverage to other areas of registration when necessary.

Requirements

• High school diploma or equivalent (Required).
• College education or 2 years of experience (Preferred).
• Minimum of two years' hospital revenue cycle experience (Preferred).
• Physician billing/reimbursement experience (Helpful).
• Demonstrated expertise in patient accounting management and billing systems, including their uses, capabilities, and limitations.
• Experience with coding (CPT, diagnosis, revenue, and insurance codes, etc.) and a working knowledge of billing regulations, including but not limited to Medicare IP PPS and OPPS, Medicaid, and commercial billing guidelines.
• Strong understanding of Hospital Charging and rate structure.