Revenue Integrity Specialist

The Revenue Integrity Specialist coordinates, evaluates and measures revenue integrity operations; develops systems to manage medical necessity denials; and develops tracking mechanisms to measure loss leaders and improvements by service line, payer and provider.

• Document and track all RAC and Payer audit requests including maintaining the RAC and Arthur Databases to ensure that all timelines are met.
• Manager the submission of records and respond to denials and appeals requests.
• Share RAC findings with key members of the organization.
• Coordinate and manage numerous RAC notifications in varying phases of appeal based on feedback.
• Log, notify, and scan all Government correspondence coming into the facility ensuring that all appropriate parties are informed.
• Maintains e-requests.
• Works with departments which impact the hospital's ability to develop and document processes which facilitate clean automated billing of hospital claims.
• This includes identification of people, process, and technology issues, development of appropriate solutions, participation in roll-out of the process improvement solutions, and ongoing monitoring.
• Will participate on existing teams and initiate and lead project teams as needed.
• Works with Scheduling, Registration, Clinical Departments, Health Information Management, and the Business Office to ensure all staff that impact the revenue cycle receive needed education and competency assessment.
• Assists in the preparation of educational material and provides education as needed.
• Works directly with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office personnel to ensure the hospital receives all reimbursement to which it is entitled through appropriate charging and coding of patient claims.
• Assists with SOX audits, insurance denial appeals and patient charge concerns/complaints as needed.
• Participates in the development of policies and procedures and ensures compliance within the Revenue Cycle.
• Participates and collaborates in resolution of the Revenue Cycle issues and refinement of the process to prevent future issues.
• Keeps informed of current healthcare-revenue cycle trends and regulatory changes.
• Verifies insurance benefits and obtains precertification/authorization as necessary.
• Determines and accepts required payments, including co-pays and deductibles, or refers to financial counselors for follow up.
• Performs medical necessity check, when appropriate (if not already done so in scheduling or pre-registration process).
• Able to provide coverage to other areas of registration when necessary.

• Knowledgeable and experienced with Hospital bill processing and insurance practices.
• HCPC/CPT/UB04 experience, modifiers, Medicare APC's, and billing regulations required.
• Experience in reimbursement analysis, good written and verbal communication skills, demonstrated knowledge of Medical Terminology, strong organizational skills and the ability to multi-task.
• Strong computer skills including Excel and the ability to interact positively with internal and external customers.
• Skills in researching and resolving problems, issues and ability to articulate audit findings.
• Must be willing to learn new tasks and be a self-starter.
• Able to perform work duties with minimal supervision.

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. UPHS - Marquette is a 222 bed hospital in Marquette, MI and houses the region's only Level II Trauma Center and Neonatal Intensive Care Unit (NICU). We also provide outreach with programs like annual health and safety fairs, health screenings for the entire family and more to keep our community healthy!