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Quorum Health · 9 hours ago

Revenue Integrity Specialist

United States

Full-time

Remote

Senior Level

5+ years exp

Quorum Health is seeking a Revenue Integrity Specialist to provide analytic support and claims resolution related to revenue cycle needs. The role involves analyzing data, resolving claims processing issues, and ensuring compliance with charging guidelines while collaborating with clinical and financial teams.

Health CareHospital

Responsibilities

Responsible for analyzing and presenting data in coordination with clinical and financial management goals, benchmarks, and objectives in assigned areas

Complies daily with departmental policies and procedures

Support and assist Hospital and Physician team members with difficult issues concerning work, clients and/or insurance carriers; offer suggestions to assist in process of underpayment reviews and collections

Resolves claims processing issues with commercial and governmental payers and provide all required information timely; involves patients and family members (where necessary) to ensure timely resolution of claims with insurance companies

Responsible for making sure the facilities understand the standard charging guidelines and how to correct charge errors going forward

Resubmits clean and accurate claims to insurance companies in a timely and compliant manner

Researches, prepares, and submits appeals to insurance companies

Details all actions taken on account with clear and concise notes

Monitors and recognizes denials and/or issues that may be trends and escalate to supervisor as needed

Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations

Perform various monitoring tasks that identify revenue integrity opportunities

Working knowledge of Athena

Works closely with Department management to facilitate root issue remediation

Complete claims resolutions timely, accurately while meeting department benchmarks

Present data, analysis, and recommendations for solutions in meetings with departmental management

Reviews and analyzes 'Explanation of Benefits' (EOBs), payer correspondences to identify denials that can be appealed. Perform denials analysis to reduce controllable rejections

Perform deep-dive analysis to find solutions that can benefit multiple specialties

Performs other duties as assigned

Qualification

Revenue cycle knowledgeClaims resolutionMedical coding knowledgeA/R managementExcel proficiencyAnalytical skillsCommunication skillsDetail orientedProblem-solving skills

Required

Education – High School Diploma or equivalent

5+ years in relevant Healthcare experience

Knowledge of basic medical coding/terminology and commercial/government insurance operating procedures and practices

Understands payer guidelines related to effective claim resolution

Knowledgeable and proficient with payer websites and other useful resources; Knowledge of revenue cycle and/or business office procedures

Highly detail oriented and organized

Ability to read, understand, and follow oral and written instructions

Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Quorum Health Systems

Strong verbal and written communication skills

Ability to work independently and follow-through and handle multiple tasks simultaneously

Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self-pay reimbursement concepts and overall operational impact

Demonstrated advanced skills in A/R management, problem assessment, and resolution, and collaborative problem-solving in complex, interdisciplinary settings

Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution

Advanced skills in using excel to maneuver through large volumes of data