Lifepoint Health®
Overview
Revenue Integrity Specialist at Lifepoint Health®. Responsibilities
Coordinate, evaluate and measure revenue integrity operations; develop systems to manage medical necessity denials; and develop tracking mechanisms to measure loss leaders and improvements by service line, payer and provider. Document and track all RAC and payer audit requests and ensure timelines are met. Manage submission of records, respond to denials and appeals requests, and share RAC findings with key members of the organization. Coordinate and manage RAC notifications in varying phases of appeal based on feedback. Log, notify, and scan all government correspondence; maintain e-requests and ensure appropriate parties are informed. Collaborate with departments to develop and document processes that facilitate clean automated billing of hospital claims, including identifying people, processes and technology issues and participating in process improvement rollouts. Participate on existing teams and lead project teams as needed. Work with Scheduling, Registration, Clinical Departments, Health Information Management and the Business Office to educate staff and assess competency related to the revenue cycle. Assist in preparing educational materials and provide education as needed. Collaborate with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office personnel to maximize reimbursement through proper charging and coding of patient claims. Assist with SOX audits, insurance denial appeals and patient charge concerns as needed. Participate in policy and procedure development and ensure compliance within the Revenue Cycle; contribute to issue resolution and process refinement to prevent future issues. Stay informed of current healthcare revenue cycle trends and regulatory changes. Verify insurance benefits and obtain precertification/authorization as necessary. Determine and collect required payments, including co-pays and deductibles, or refer to financial counselors for follow up. Perform medical necessity checks when appropriate (if not already done during scheduling or pre-registration). Able to provide coverage to other areas of registration when necessary. Qualifications And Requirements
Education: High school diploma or equivalent required. College education or 2 years experience preferred. Knowledgeable with hospital bill processing and insurance practices; HCPCS/CPT/UB04 experience, modifiers, Medicare APCs, and billing regulations required. Experience in reimbursement analysis, strong written and verbal communication skills, knowledge of Medical Terminology, strong organizational skills and ability to multi-task. Strong computer skills including Excel; ability to interact positively with internal and external customers; good problem-solving and audit communication abilities. Must be willing to learn new tasks and be a self-starter; able to perform work duties with minimal supervision. Two years of hospital revenue cycle experience preferred; physician billing/reimbursement experience helpful. Demonstrated expertise in patient accounting management and billing systems; experience with coding (CPT, diagnosis, revenue and insurance codes); working knowledge of Medicare IP PPS, OPPS, Medicaid and commercial billing guidelines; strong understanding of hospital charging and rate structure. Requires prolonged sitting for calls; routine standing, bending, stooping; lifting up to 25 pounds; full range of motion and effective communication skills. Essential Functions
Document and track RAC and payer audit requests; maintain RAC and Arthur Databases to ensure timelines are met. Manage submission of records, respond to denials and appeals; share RAC findings with key stakeholders. Coordinate RAC notifications in varying appeal phases based on feedback. Log and scan all government correspondence; inform appropriate parties; maintain e-requests. Collaborate with departments to develop processes that facilitate clean automated billing of hospital claims; identify issues and participate in process improvement rollouts. Lead and participate in project teams as needed; educate staff across departments on revenue cycle processes. Ensure staff education and competency assessment for those impacting the revenue cycle. Assist with education materials and training as required. Work with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office to maximize reimbursement through proper charging and coding. Assist with audits, insurance denial appeals and patient charge concerns as needed. Participate in policy development, compliance, and ongoing revenue cycle improvements. Keep informed of healthcare revenue cycle trends and regulatory changes. Verify benefits and obtain precertification/authorization as necessary; determine and collect payments or refer to counselors for follow up. Perform medical necessity checks when appropriate and cover other areas of registration when needed. Benefits
Health (Medical, Dental, Vision) and 401K Benefits for full-time employees Competitive Paid Time Off Employee Assistance Program for mental, physical, and financial wellness Tuition Reimbursement/Assistance for qualified applicants And much more... About Us
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. UPHS - Marquette is a 222 bed hospital in Marquette, MI with the region's only Level II Trauma Center and NICU. We offer community outreach and health programs to keep our community healthy. Marquette offers a rural landscape, recreational activities, and welcoming people. EEOC Statement
UP Health System - Marquette is committed to providing Equal Employment Opportunities for all applicants and employees and complies with laws prohibiting discrimination on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans status, or any other protected status.
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Revenue Integrity Specialist at Lifepoint Health®. Responsibilities
Coordinate, evaluate and measure revenue integrity operations; develop systems to manage medical necessity denials; and develop tracking mechanisms to measure loss leaders and improvements by service line, payer and provider. Document and track all RAC and payer audit requests and ensure timelines are met. Manage submission of records, respond to denials and appeals requests, and share RAC findings with key members of the organization. Coordinate and manage RAC notifications in varying phases of appeal based on feedback. Log, notify, and scan all government correspondence; maintain e-requests and ensure appropriate parties are informed. Collaborate with departments to develop and document processes that facilitate clean automated billing of hospital claims, including identifying people, processes and technology issues and participating in process improvement rollouts. Participate on existing teams and lead project teams as needed. Work with Scheduling, Registration, Clinical Departments, Health Information Management and the Business Office to educate staff and assess competency related to the revenue cycle. Assist in preparing educational materials and provide education as needed. Collaborate with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office personnel to maximize reimbursement through proper charging and coding of patient claims. Assist with SOX audits, insurance denial appeals and patient charge concerns as needed. Participate in policy and procedure development and ensure compliance within the Revenue Cycle; contribute to issue resolution and process refinement to prevent future issues. Stay informed of current healthcare revenue cycle trends and regulatory changes. Verify insurance benefits and obtain precertification/authorization as necessary. Determine and collect required payments, including co-pays and deductibles, or refer to financial counselors for follow up. Perform medical necessity checks when appropriate (if not already done during scheduling or pre-registration). Able to provide coverage to other areas of registration when necessary. Qualifications And Requirements
Education: High school diploma or equivalent required. College education or 2 years experience preferred. Knowledgeable with hospital bill processing and insurance practices; HCPCS/CPT/UB04 experience, modifiers, Medicare APCs, and billing regulations required. Experience in reimbursement analysis, strong written and verbal communication skills, knowledge of Medical Terminology, strong organizational skills and ability to multi-task. Strong computer skills including Excel; ability to interact positively with internal and external customers; good problem-solving and audit communication abilities. Must be willing to learn new tasks and be a self-starter; able to perform work duties with minimal supervision. Two years of hospital revenue cycle experience preferred; physician billing/reimbursement experience helpful. Demonstrated expertise in patient accounting management and billing systems; experience with coding (CPT, diagnosis, revenue and insurance codes); working knowledge of Medicare IP PPS, OPPS, Medicaid and commercial billing guidelines; strong understanding of hospital charging and rate structure. Requires prolonged sitting for calls; routine standing, bending, stooping; lifting up to 25 pounds; full range of motion and effective communication skills. Essential Functions
Document and track RAC and payer audit requests; maintain RAC and Arthur Databases to ensure timelines are met. Manage submission of records, respond to denials and appeals; share RAC findings with key stakeholders. Coordinate RAC notifications in varying appeal phases based on feedback. Log and scan all government correspondence; inform appropriate parties; maintain e-requests. Collaborate with departments to develop processes that facilitate clean automated billing of hospital claims; identify issues and participate in process improvement rollouts. Lead and participate in project teams as needed; educate staff across departments on revenue cycle processes. Ensure staff education and competency assessment for those impacting the revenue cycle. Assist with education materials and training as required. Work with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office to maximize reimbursement through proper charging and coding. Assist with audits, insurance denial appeals and patient charge concerns as needed. Participate in policy development, compliance, and ongoing revenue cycle improvements. Keep informed of healthcare revenue cycle trends and regulatory changes. Verify benefits and obtain precertification/authorization as necessary; determine and collect payments or refer to counselors for follow up. Perform medical necessity checks when appropriate and cover other areas of registration when needed. Benefits
Health (Medical, Dental, Vision) and 401K Benefits for full-time employees Competitive Paid Time Off Employee Assistance Program for mental, physical, and financial wellness Tuition Reimbursement/Assistance for qualified applicants And much more... About Us
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. UPHS - Marquette is a 222 bed hospital in Marquette, MI with the region's only Level II Trauma Center and NICU. We offer community outreach and health programs to keep our community healthy. Marquette offers a rural landscape, recreational activities, and welcoming people. EEOC Statement
UP Health System - Marquette is committed to providing Equal Employment Opportunities for all applicants and employees and complies with laws prohibiting discrimination on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans status, or any other protected status.
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