This position reports to the Revenue Integrity Manager. The Revenue Integrity Specialist II is responsible for timely and accurate determination of payor underpayments and overpayments on all lines of business. The Revenue Integrity Specialist II is also primarily responsible for identifying Blue Cross underpayments via the Experience Report and working with the payor to resolve underpayment variances.
- High School graduate or equivalent
- Previous Collections or Insurance experience within last 3 years, preferred
- Excellent guest relation skills, including verbal and written
- Excellent computer, communication and interpersonal skills required
- ICD/CPT/HCPCS and Medical terminology preferred
- PC and Keyboarding Skills (30 WPM preferred)
- Ability to work independently
- Two years hospital patient accounting experience, preferred
Licenses and Certifications:
- HFMA Credentialed Revenue Cycle Representative (within 3 years of hire)
Work Schedule: Days
Location: Hoover - Kankakee
- Daily review of underpayment and overpayment variances identified by 835 files, manually posted R/As, EOBs, or Payer Correspondence in the Patient Accounting and/or Scanning system.
- Daily review of the Experience Report system, determining underpayments by Blue Cross and timely follow up with Blue Cross on all identified underpayments.
- Timely follow up on all successfully submitted appeals, by use of workqueues, reports and ATBs, until a determination is made on the appeal.
- Review daily reports to ensure that contractual adjustments are posted daily.
- Provide monthly variance analytics and underpayment trends to the Revenue Integrity Manager. Offer suggestions for process improvements to areas involved.
- Identify and communicate system issues related to variances stemming from billing, edits, rejections and follow up work queues with the Epic Contract Managers and Revenue Integrity Manager.
- Submit help tickets and work with Epic Contract Managers and/or Analytics to resolve issues, including testing and training as necessary.
- Develop, implement and evaluate existing policies and procedures in the database. Work with Epic Certified Trainer to develop tip sheets and visios.
- Maintain attendance at Managed Care In-services, onsite meetings and conference calls with Insurance Provider Representatives (as necessary).
- Maintain education on reimbursement and billing requirements as defined by the contract, state, or federal law in maintaining compliance with these rules.
- Perform as a liaison between outsourced agencies and provide all necessary requested information to the agency.
- Provide training to peers assisting with variances.
- Assist other Analysts or Coordinators as needed.
Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals® by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.
Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago’s southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedication is respected, where superior performance is rewarded with competitive salaries and excellent benefits.
Medical Billing And Coding