Memorial Health System
Revenue Integrity Claims Specialist - Revenue Integrity - Days - FT
Memorial Health System, Biloxi, Mississippi, United States, 39531
Revenue Integrity Claims Specialist - Revenue Integrity - Days - FT
Job Description
The Revenue Integrity Claims Specialist is responsible for coordinating claim edit and rejection review with reference to billing compliance guidelines across all payors. The Claims Specialist trends and facilitates the follow up of billing issues and denials with the revenue staff to decrease delays in claim submission and promote efficiency and revenue integrity. The Claims Specialist resolves claim errors, edits, and other holds and identifies trends and opportunities for improvement. The Claims Specialist develops and delivers education to staff regarding workflows, compliance guidelines and regulatory requirements.
Responsibilities Coordinates claims correction to promote reimbursement
Reviews rejected claims to identify errors and necessary action
Facilitates claim correction with revenue staff and provides instructions on addressing deficiencies
Follows up on correction status to ensure timely resolution
Documents errors and reports findings to the appropriate team member
Investigates and resolves claim errors through utilization of resources
Gathers missing or incomplete claim information
Collaborates with external resources to resolve rejections
References policies and guidelines to ensure payor compliance
Performs claims corrections and edits as appropriate
Evaluates rejection causes and identifies opportunities for efficiency and improvement
Performs analysis of denied claims to identify trends impacting revenue collection
Assesses workflow processes and recommends changes to prevent rejections
Educates team members in developing and maintaining initiatives geared towards quality improvement
Reviews educational needs and develops training related to claims processes
Through ongoing training and requirements, ensures compliance with organizational standards and regulatory requirements
Qualifications Associates degree or High School Diploma/ Equivalent with required experience.
Four years of experience (with Associates degree) or six years of experience (with no degree) in a revenue cycle role including billing and follow up.
Location Biloxi Annex, 220 Popps Ferry Road
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Responsibilities Coordinates claims correction to promote reimbursement
Reviews rejected claims to identify errors and necessary action
Facilitates claim correction with revenue staff and provides instructions on addressing deficiencies
Follows up on correction status to ensure timely resolution
Documents errors and reports findings to the appropriate team member
Investigates and resolves claim errors through utilization of resources
Gathers missing or incomplete claim information
Collaborates with external resources to resolve rejections
References policies and guidelines to ensure payor compliance
Performs claims corrections and edits as appropriate
Evaluates rejection causes and identifies opportunities for efficiency and improvement
Performs analysis of denied claims to identify trends impacting revenue collection
Assesses workflow processes and recommends changes to prevent rejections
Educates team members in developing and maintaining initiatives geared towards quality improvement
Reviews educational needs and develops training related to claims processes
Through ongoing training and requirements, ensures compliance with organizational standards and regulatory requirements
Qualifications Associates degree or High School Diploma/ Equivalent with required experience.
Four years of experience (with Associates degree) or six years of experience (with no degree) in a revenue cycle role including billing and follow up.
Location Biloxi Annex, 220 Popps Ferry Road
#J-18808-Ljbffr