The Specialist Revenue Integrity supports the census, client billing, and insurance billing processes by completing assigned order entry edits and adding pertinent data, such as mileage and draw fees, to ensure timely and complete billing. The Specialist works in conjunction with offshore staff to enter data needed to meet contractual, compliance and third-party reimbursable guidelines in a timely manner.
Essential Job Functions:
• Completes order entry and transfer queue edits assigned. Utilizes worklists provided by Supervisor to prioritize works. Adds note to billing system and on worklist per protocol.
• Calculates mileage traveled by phlebotomists for client billing and claim submissions. Enters mileage information timely aligned with month end close billing protocols.
• Utilizes insurance discovery or found insurance portal to resolve insurance errors or discrepancies requiring manual review.
• Collaborates with Supervisor to resolve any discrepancies and concerns regarding Client monthly invoices.
• Meets or exceeds productivity and quality performance metric.
• Participates in weekly business review meetings with the offshore team as appropriate.
• Assists Supervisor with documenting current workflows, policies and standard operating procedures for development of training material.
• Supports IT with testing new features and functions in the practice management system.
• Remains current with trends, regulatory requirements, and business strategies related to the payer relations and revenue cycle.
• Operates in compliance with all local, state and Federal laws as well as policy and compliance standards.
• All other duties as assigned.
Education and Experience:
• High School diploma or equivalent required. College coursework or A.A. degree preferred.
• 2 – 3 years-experience working with patient records or clinical documentation in a healthcare or provider setting.