Revenue Integrity Data Specialist

  • Capital Health
  • Lawrenceville, Lawrence Township, NJ, USA
  • Oct 28, 2021
Full Time Administration/Operations

Job Description

Under the direction of Revenue Cycle Analyst, responsible for analysis, coordination,
monitoring, education and support as it relates to originating process factors which lead to
denials and over/underpayments. Focuses on resolution of operational practices leading to non-
optimal trends in initial claim submission and payment patterns. Performs root cause analysis
behind denial patterns and identifies improvement opportunities to Revenue Cycle leaders.
Facilitates process standardization to promote improved outcomes, maximize resource
utilization, and improve organizational efficiencies. Serves as a subject matter expert to the
Patient Accounts leadership team.

ESSENTIAL FUNCTIONS

  • Reviews and summarizes trend analyses from denial software system reports, identifies
    and develops program components to mitigate identified anomalies within the data.
  • Provides ongoing evaluation and assessment of hospital practices and industry changes
    to ensure the enterprise remains current in processes related to appeals and denials.
  • Provides daily support and subject matter expertise to organizational leadership, and
    identifies areas of opportunity for continuous improvement including ongoing
    education and resources as needed.
  • Partners with the Contract Management Specialist to engage with different payers to
    provide feedback regarding trends and issues. Assures compliance of payers to
    regulatory guidelines.
  • Audits medical chart to final bill based on denial software profile results.
  • Engages with hospital service line leaders for the purposes of information gathering to
    enhance revenue cycle opportunities.
  • Coordinates with Contract Management Specialist on contract management valuation
    issues resulting in payment discrepancy.
  • Communicates with denial software vendor on a regular basis, monitors software for
    accuracy and identifies and rectifies software discrepancies.
  • Assesses, monitors and maintains completeness of denial software through ongoing
    reconciliation methods between payment received via 835 files and payment posting
    transactions.
  • Prepares weekly and monthly revenue cycle scorecards.

Qualifications

MINIMUM REQUIREMENTS

Education:

  • Associate's Degree in Business or a related field
  • OR High School Diploma with 5 years experience in lieu of degree

Experience:

  • 2 years experience in hospital or physician group revenue cycle or finance departments.
  • Familiarity with ICD-10/CPT coding and medical terminology.
  • Previous clinical and chart/bill auditing experience preferred. 

Knowledge and Skills:

  • Excellent planning and organizational skills.
  • Demonstrated leadership, communication and problem solving skills and the ability to act/decide accordingly.
  • Exceptional customer service skills.
  • Strong analytical and critical thinking skills in a rapidly changing environment.
  • Excellent planning

Special Training:

  • Proficiency in Microsoft Office applications.
  • Working knowledge of insurance contracting principles and payer administrative policies. 
  • Ability to function with minimal supervision and exercise sound judgment.
  • Ability to collect, create and research complex or diverse information.

Schedule

Full time, days

Employment Type (feed only)

Full Time, Permanent