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UnityPoint Health Revenue Cycle Integrity Specialist in Waterloo, Iowa

Revenue Cycle Integrity Specialist

Waterloo, IA

Full-time: Monday-Friday 8am-5pm

The Revenue Cycle Integrity Specialist is a key member of the UnityPoint Clinic regional administrative team reporting directly to the Patient Access Supervisor. This position is responsible for working work queues, identifying trends and collaboratively working with departments to improve the revenue cycle performance within the region. This position requires strong decision-making ability around charging issues, complex claims processing workflows and regulations that requires utilization of data coming from multiple resources. To evaluate charging and billing issues appropriately, Specialists will need to understand the entire Revenue Cycle. This role will have ongoing interaction with leadership, revenue cycle staff, coding staff, billing staff, and IT teams.

This individual will focus on supporting continuous improvement in key revenue cycle functions

including Registration, Coding, and Billing. The Specialist will maintain a good working relationship with all affiliates to ensure clear communication and a collaborative approach to implementing best practice processes.

Revenue Cycle Specialist Responsibilities

· Resolve billing errors/edits, charge review edits and claim edits including accounts with Stop Bills and “DNBs” to ensure all claims are filed in a timely manner.

· Provide timely feedback to management of identified charging issues within departments, claims issues, repetitive errors, and payer trends to expedite claims adjudication.

· Work accounts in assigned queues in accordance with departmental guidelines.

· Assists with analyzing data to identify opportunities for process improvement. Assist with development of reporting that will create accountability and drive change.

· Assists with critical Revenue Cycle projects by collaborating with key stakeholders across UnityPoint Clinic. These projects affect business operations to a substantial degree.

· Assists with collection, monitoring and analyzing data, and gives feedback to management for recommendations to leadership to drive better performance throughout the revenue cycle.

· Provides expert consultation to leadership as the subject matter expert for revenue cycle data.

· Interprets existing revenue cycle policies and operating practices to make recommendations for improvements.

30 %

Performance Monitoring/Revenue Integrity

· Identifies different types of data that require tracking to improve revenue cycle performance.

· Provide timely feedback to management of identified charging issues, repetitive errors, and payer trends to expedite claims adjudication.

· Work with Directors and regional Ambulatory VP to prioritize suggested changes.

· Provides training as needed to improve operations.

30 %

Denials Management

· Work with leadership and staff to identify and remediate denials through rules and EMR build.

· Assist with reports that track performance and are easy-to-interpret.

· Develop an understanding of complex rules and regulations governing insurance, appeal activities, trends, etc. and make recommendations on system build to accommodate changes in these areas.

· Develop an understanding of the entire revenue cycle and the factors that lead to denials and revenue loss.

30%

Basic UPH Performance Criteria

· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

· Demonstrates ability to meet business needs of department with regular, reliable attendance.

· Employee maintains current licenses and/or certifications required for the position.

· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

· Completes all annual education and competency requirements within the calendar year.

· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

10%

Minimum Requirements

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

High School Diploma or GED

Bachelor’s degree in Healthcare Administration, Business, Mathematics or Computer Science.

Experience:

2 years’ experience in healthcare analytics or medical billing

License(s)/Certification(s):

Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

Strong skills including professionalism, interpersonal skills, ability to communicate effectively through written and verbal methods, process improvement skills.

Fluent with Epic and Microsoft office programs. Ability to manipulate large amounts of data.

Other:

Use of usual and customary equipment used to perform essential functions of the position.

Requisition ID: 2020-83983

Street: 2413 W Ridgeway

Name: 9200 UnityPoint Clinic Affiliate

Name: Administration- WL

FLSA Status: Non-Exempt

Scheduled Hours/Shift: Monday-Friday, 8am-5pm

External Company URL: http://www.unitypoint.org

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