Revenue Integrity Specialist

Your experience matters

At UP Health System - Marquette, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• 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
• And much more...

About Us

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!

In Marquette our fascinating history, rural landscape, abundant recreational opportunities, and welcoming people make the Upper Peninsula someplace special. From a thriving culinary scene to charming shops to historic lighthouses and museums, there is something for everyone in this beautiful lakeside gem.

How you'll contribute

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.

Qualifications and requirements

Education: High school diploma or equivalent Required. College education or 2 years experience preferred

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.

Two years' hospital revenue cycle experience preferred. Physician billing/reimbursement experience helpful. Demonstrated expertise in patient accounting management and billing systems including their uses, capabilities and limitations. Experience with coding (CPT, diagnosis, revenue and insurance codes, etc.) and a working knowledge of billing regulations, including but not limited to Medicare IP PPS and OPPS, Medicaid and commercial billing guidelines, a must. Strong understanding of Hospital Charging and rate structure

Requires prolonged sitting while initiating or receiving telephone calls. Requires frequent standing, bending and stooping. Requires lifting of up to 25 pounds. Required full range of motion including eye-hand coordination and manual dexterity. Requires ability to communicate and interact with others in person and on the telephone.

Essential functions:

• 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.

EEOC Statement:

UP Health System - Marquette is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.