Revenue Integrity Specialist - Days at INTEGRIS Health
INTEGRIS Health · Oklahoma City, United States Of America · Hybrid
- Professional
- Office in Oklahoma City
INTEGRIS Health, Oklahoma’s largest not-for-profit health system has a great opportunity for a Revenue Integrity Specialist in Oklahoma City, OK. In this position, you’ll work 8a-5p, Full-time, with our team providing exceptional care to those who have entrusted INTEGRIS Health with their healthcare needs. If our mission of partnering with people to live healthier lives speaks to you, apply today, and learn more about our increased compensation plans and recently enhanced benefits package for all eligible caregivers such as front-loaded PTO, 100% INTEGRIS Health paid short-term disability, increased retirement match, and paid family leave. We invite you to join us as we strive to be The Most Trusted Partner for Health.
The Revenue Integrity Specialist is responsible for analyzing governmental regulations and the impact regarding our revenue cycle processes throughout INTEGRIS Health facilities system. This position is responsible for the assessment and analysis of diverse data related to the revenue cycle for all facilities. In addition, this position is responsible for the completion of Medicare Part A Enrollment applications for INTEGRIS Health including hospitals, home health agencies, hospice agencies, and durable medical equipment, prosthetics, orthotics, and supplies (DEMPOS). INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer.
Responsibilities
The Revenue Integrity Specialist responsibilities include, but are not limited to, the following:
- Prepares and analyzes reports on a regular basis, including Medicare and Medicaid remittance denial data, and works with Revenue Integrity Manager to help resolve related issues.
- Analyzes and prepares monthly reports for all INTEGRIS Health facilities and Contracting and Revenue Recovery management team.
- Assist the Revenue Integrity Manager and Administrative Director of Contracting and Revenue Recovery with proposed operational issues to improve the Revenue Integrity processes throughout the INTEGRIS Health System.
- Manages and maintains accurate information for submitting and tracking appeals and outcomes of audits that are being disputed in the Recovery Audit Contractor (RAC) database as well as other databases.
- Creates return on investment analysis for the Recovery Auditor Contractor (RAC) and Revenue Integrity audits.
- Performs complex claims analysis and assists with appeals of audits that are being disputed, documents and tracks the appeals process and outcomes for Recovery Audit Contractor (RAC) audits for all INTEGRIS facilities.
- Analyzes claims data for trends and potential vulnerabilities in billing patterns and assists with implementation of corrective action across the system.
- Communicates the status of audits and appeals by federal healthcare programs to key people throughout the INTEGRIS Health system.
- Completes Medicare Part A Provider Enrollment applications (CMS-855A form) ensuring accurate and timely submission of information as required by CMS regulations.
- Consults with INTEGRIS Health Legal Services to ensure Medicare Part A Provider Enrollment applications are completed appropriately.
- Responds promptly and within specified timeframes to Medicare inquiries regarding provider enrollment applications and maintains organized files of all correspondence.
- Establishes and maintains access for INTEGRIS Health entities within the CMS internet-based Provider Enrollment, Chain and Ownership System (PECOS). Reports to the Manager of Revenue Integrity.
This position may have additional or varied physical demand and/or respiratory fit test requirements.
Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.
Risk exposure is minimal.
Required to meet strict deadlines with limited resources.
Must drive to facilities throughout the metro and rural areas.
Some overnight travel required.
All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.
Qualifications
- Bachelor's degree in related field and 2 years of related experience; or associate's degree in related field and 4 years related experience: or 6 years of related experience
- 2 years' experience with DRG, ICD 10, and CPT-4 medical record coding and UB04-92/CMS-1500 claim billing and relevant compliance experience
- Previous work experience in managed care and government billing preferred
- Previous experience in Medicare provider enrollment preferred
- Computer experience (MS Word, Excel, Access, Outlook)
- Must be able to communicate effectively in English (verbal/written)
- Advanced certifications preferred (e.g. CCS, CPC, CPC-H)
- Knowledge of regulatory compliance issues, ICD-9 and CPT-4 medical record coding and UB04/HCFA 1500 claim billing
- This job requires the incumbents to operate an INTEGRIS-owned vehicle OR personal vehicle (non-INTEGRIS-owned) and, therefore, must have a current Oklahoma State Driver's License as well as a driving record which is acceptable to our insurance carrier.
Company
To our patients, that means we will partner to provide unprecedented access to quality and compassionate health care. To you, it means some of the state's best career and development opportunities. With INTEGRIS Health, you will have a genuine chance to make a difference in your life and your career.
INTEGRIS Health is the state's largest Oklahoma-owned health system with hospitals, rehabilitation centers, physician clinics, mental health facilities and home health agencies throughout much of the state.
