Revenue Integrity Specialist

We are seeking a Revenue Cycle Integrity Specialist to join our team! This role is a key member of the Revenue Cycle Team reporting directly to the Manger of Revenue Integrity. This position is responsible for working work queues, identifying trends and collaboratively working with departments to improve the revenue cycle performance within UnityPoint Health. This position requires strong decision-making ability around charging issues, complex claims processing workflows and regulations that requires utilization of data coming from multiple resources. To evaluate charging and billing issues appropriately, Specialists will need to understand the entire Revenue Cycle. This role will have ongoing interaction with leadership, revenue cycle staff, coding staff, billing staff, and IT teams.

This individual will focus on supporting continuous improvement in key revenue cycle functions

including Registration, Coding, and Billing. The Specialist will maintain a good working relationship with all affiliates to

ensure clear communication and a collaborative approach to implementing best practice processes.

Revenue Cycle Specialist

• Resolve billing errors/edits, charge review edits and claim edits including accounts with Stop Bills and “DNBs” to ensure all claims are filed in a timely manner.
• Responsible for decision making to improve and impact charge issues, complex claims processing workflows and regulations
• Responsible for providing information to leadership to identified charging issues within departments, claims issues, repetitive errors, and payer trends to expedite claims adjudication.
• Assists with analyzing data to identify opportunities for process improvement. Assist with development of reporting that will create accountability and drive change.
• Assists with critical Revenue Cycle projects by collaborating with key stakeholders across UnityPoint Health. These projects affect business operations to a substantial degree.
• Interprets existing revenue cycle policies and operating practices to make recommendations for improvements.
• Responsible for maintaining in-depth understanding of the entire revenue cycle. Responsible for troubleshooting registration, coding, and correct coding initiative (CCI) edits.
• Research and resolve charge review, claim edit, and denial in assigned work ques(WQ).
• Liaison for the billing office team members. Answering questions and troubleshoot accounts as needed.

Performance Monitoring/Revenue Integrity

• Responsible for applying knowledge of revenue cycle principles to ensure accurate and compliant billing
• Assists with collection, monitoring and analyzing data, and gives feedback to management for recommendations to leadership to drive better performance throughout the revenue cycle.
• Responsible for identifying, reaching, and analyzing billing errors or omissions for different types of data that require tracking to improve revenue cycle performance.
• Work with Revenue Integrity Analysts and Directors to prioritize recommend changes.
• Identifies training opportunities and provides training as needed to improve operations.

Denials Management

• Work with leadership and staff to identify and remediate denials through rules and EMR build.
• Assist with reports that track performance and are easy-to-interpret.
• Understand complex rules and regulations governing insurance, appeal activities, trends, etc. and make recommendations on system build to accommodate changes in these areas.
• Responsible for understanding of the entire revenue cycle and the factors that lead to denials and revenue loss.

Education

• H.S. diploma/GED required
• Bachelor’s degree in Healthcare Administration, Business, Mathematics or Computer Science preferred.

Experience

• 2 years of progressive experience in revenue cycle/medical billing

Knowledge/Skills/Abilities

• Strong skills including professionalism, interpersonal skills, ability to communicate effectively through written and verbal methods, process improvement skills.
• Fluent with Epic and Microsoft office programs.  Ability to manipulate large amounts of data.
• Demonstrated decision making as it relates to processing, reconciling, and ensuring the accuracy of revenue and charge activity.
• Knowledge of entire revenue cycle process
• Knowledge of medical terminology and coding