Revenue Integrity Specialist

Description

PURPOSE STATEMENT

The Revenue Integrity Specialist is responsible for ensuring reimbursement accuracy by monitoring payer payments, identifying reimbursement variances, validating expected reimbursement using contract management tools, researching underpayments and overpayments, and supporting contract compliance initiatives. This position plays a key role in protecting organizational revenue through payment integrity, contract analysis, and continuous process improvement.

ESSENTIAL FUNCTIONS

• Review payment variances using Meditech Contract Management.
• Compare expected reimbursement to actual payments.
• Identify payer underpayments and overpayments.
• Research reimbursement discrepancies.
• Coordinate payment variance appeals.
• Review payer contractual compliance.
• Monitor reimbursement trends.
• Collaborate with the Director regarding contract interpretation.
• Assist with payer implementations and fee schedule updates.
• Maintain expected reimbursement models.
• Develop reports identifying payment integrity opportunities.
• Collaborate with Payment Posting, Insurance Follow-Up, Denial Management, and Finance.
• Recommend operational and contractual improvements to maximize reimbursement.

Requirements

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

• High school diploma or equivalent.
• Bachelor’s Degree in business related field or equivalent experience required.
• Strong understanding of Acute Payer Contracts is required.
• 3+ years of healthcare billing, revenue cycle, or claims experience.
• Experience working in an EHR system (MEDITECH preferred).
• Ambulatory and Acute Billing experience.
• Current residency in the state of Missouri or Kansas is required.

Performance Metrics

• Underpayment Recovery Dollars.
• Payment Variance Resolution Time.
• Expected Reimbursement Accuracy.
• Contract Compliance.
• Payment Integrity Opportunities Identified.
• Financial Impact of Revenue Recovery.

PHYSICAL/MENTAL REQUIREMENTS

• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
• Occasionally walks on uneven surfaces.