Revenue Integrity Specialist

It's more than a career, it's a calling.

Worker Type:

Job Highlights:

Schedule: 8 hour shift with start times between 6:30am and 8:30am, Monday - Friday

Qualifications: Ideal candidate has experience with healthcare revenue cycle, billing and coding, Epic, and has a strong attention to detail.

The Revenue Integrity Specialist will contribute in the following areas:

• Assists in daily resolution of work queue/edits that are holding patient claims from billing by reviewing applicable documentation
• Identifies, reports, with escalation as needed, and participates in the resolution of any potential or actual revenue/charge related issue
• Identifies areas of common practice and implements opportunities for standardization
• Monitors EPIC Revenue Integrity Dashboard(s) in collaboration with ministry liaisons to manage and report out weekly for leadership/colleagues
• Responds to departmental charging inquiries
• Provides support for assigned ministries in collaboration with Revenue Integrity Analysts
• Works with coding and other clinical departments to identify/fix errors based on ICD/CPT coding guidelines and National Correct Coding Initiative (NCCI) edits
• Contributes to improvement initiatives as directed by department leaders, focusing on WQ accuracy of rules, naming conventions and assignments, and KPIs for performance as assigned

Remote work: This position may be eligible for remote work in accordance with SSM policies. Note that remote work is not permissible in some states; Human Resources should be consulted for additional information and guidance. 

*Candidates must reside in MO, IL, OK, or WI

Job Summary:

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Assists in daily resolution of work que/edits that are holding patient claims from billing by reviewing applicable documentation.
• Identifies, reports, with escalation as needed, and participates in the resolution of any potential or actual revenue/charge related issues.
• Identifies areas of common practice and implements opportunities for standardization.
• Monitors EPIC Revenue Integrity Dashboard(s) in collaboration with ministry liaisons to manage and report out weekly for leadership/colleagues.
• Responds to departmental charging inquiries.
• Provides support for assigned ministries in collaboration with RI Audit team.
• Works with coding and other clinical departments to identify/fix errors based on ICD/CPT coding guidelines and National Correct Coding Initiative (NCCI) edits.
• Contributes to improvement initiatives as directed by department leaders, focusing on WQ accuracy of rules, naming conventions and assignments, and KPIs for performance board as assigned.
• Performs other duties as assigned.

EDUCATION

• Associate’s degree or equivalent combination of education and experience

EXPERIENCE

• One year experience within a hospital organization or physician practice environment

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 

• None

Department:

Work Shift:

Scheduled Weekly Hours:

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 

• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

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SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.