Revenue Integrity Specialist

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Revenue Integrity Specialist
Duties: Assisting the Revenue Integrity Department with all necessary activities involving active cases and projects. Assist in gathering, digitally filing, organizing, reviewing, routing, and prioritizing all content related to active cases and projects. Assisting in thoroughly reviewing, investigating, and resolving all denied claims, underpayments, rejections, and recoupments for the entire organization. Researching and resolving cases with payment disparities, is expected to function independently with minimal supervision and is expected to interact directly with other Revenue Cycle team members, providers, payers, and patient on a daily basis. Track and Document all necessary elements in a timely and diligent fashion in the Medical Record and Denials Management system to facilitate monitoring, trending, and clear auditing. Gather, organize, sort and route correspondence and responses from a variety of source, including but not limited to physical mail, digital lock box, payor portals, etc. Follow-Up on Active Cases as Required in a timely fashion to ensure deadlines are not missed and submitted rebuttals are received and processed. Expedite the receipt of responses from payors by requesting it as it becomes available. Actively assist in identifying, investigating, and resolving denials, rejections, underpayments, and recoupments in a timely fashion on a daily basis. Work closely on a daily basis with various organizational members, including, but not limited to: Revenue Cycle Team Members, Revenue Integrity Analysts, and Clinical Staff. Work closely with various external members, including, but not limited to: Insurance Company representatives, patients, guarantors, and other third parties affiliated with reimbursement disputes and anomalies. Draft, review, finalize and submit accurate and high-quality dispute letters, justifications, notices, appeals, reconsideration requests, redetermination requests, and other communication to external parties in a timely fashion as necessary while processing reimbursement disputes and anomalies. Coordinate and Track all active cases to ensure that no opportunities or deadlines are missed. Follow-up for requested content from internal and external members to ensure timely investigation of cases and submission of findings. Assist in monitoring, trending, and performing root-cause analysis with Revenue Integrity Analysts, System Administrators, and other team members to limit and/or prevent reimbursement issues. Assist in the development and implementation of Denials, Appeals, and Dispute management systems and workflows.

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