Revenue Integrity Specialist

Description

Position Summary:

As a Revenue Integrity Specialist, your primary duties are to provide subject matter expertise, operational support, and education related to coding, billing, & documentation. You will have ongoing daily operational tasks as well as project work that supports continuous process improvement efforts related to revenue cycle efficiency and compliance for St. Joseph Regional Medical Center. You will work under the direction of the Revenue Integrity [Cycle] Director and in collaboration with multiple departments within St. Joseph Regional Medical Center, Scion Health, community partners, and revenue cycle vendors. You play a crucial role in identifying opportunities for improvement, facilitating problem-solving, implementing action plans, and developing/improving workflows. The Revenue Integrity Specialist acts as a liaison and facilitator between stakeholders, while providing excellent customer service to both internal and external customers reflective of our Values, and in support of our Mission and Vision.

About the Team:

St. Joseph Regional Medical Center is a 145-bed, acute care hospital located in Lewiston, Idaho and is the largest full-service medical center between Boise and Spokane. We provide a full range of inpatient and outpatient services as well as outpatient clinic services, crossing over multiple specialties and primary care. We want every team member to feel empowered to make the right choices for our patients, themselves, our team, & our community. Our Revenue Integrity team embraces continuous process improvement & learning, open communication, and collaborative decision-making with stakeholders. Our team values taking care of our patients and each other. We encourage kindness, critical thinking, fun, collaboration, continuous learning, and a supportive environment to work and serve our community!

Essential Functions/Primary Duties:

• Work collaboratively with patient care departments & support departments to improve revenue cycle performance.
• Provide education & training to physicians, non-physician practitioners, and staff.
• Analyze data to identify opportunities for improvement and/or to validate processes and workflows are effective.
• Summarize findings and when needed, make recommendations for solutions to prevent the recurrence of errors.
• Lead and/or support various process improvement initiatives as requested.
• Maintain current knowledge of billing & coding guidelines.
• Maintain current knowledge of payment methodologies and regulatory guidelines impacting revenue cycle.
• Perform job functions within applicable state & federal guidelines.
• Navigate within electronic medical record systems, payer systems, and revenue cycle vendor applications.
• Under the direction of the Revenue Integrity [Cycle] Director, assist in creating internal resources and quick references (i.e. topic-specific regulatory guidance, payer coverage policies, workflow process maps, workflow checklists, etc.)
• Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of job duties.
• Maintain a clean, professional, and organized workspace, including electronic systems. Email & outlook calendar should be used throughout your shift and kept organized and up to date.
• Complete all mandated training/education promptly and completely upon hire and as required thereafter.
• Other assigned duties that support departmental and/or organizational objectives in support of our Mission, Vision, and Values.
  
  

Travel Required: Travel between hospital campus and off-campus locations

Qualifications

Required Education Level:

• High school diploma or equivalent
  
  

Required Experience:

• Minimum of 5 years working in a revenue cycle role where medical coding was a significant portion of your job.
• Minimum of 2 years working in a revenue cycle role where medical billing was a significant portion of your job.
  
  

Required Licensure and/or Certification(s):

• Active medical coding certification from an accredited organization required. (Note: Healthcare provider education is a key job function, as such, certification must include professional coding component).
  
  

Required Skills:

• Advanced working knowledge of ICD-10, CPT, and HCPC guidelines and the ability to apply knowledge when performing job functions.
• Advanced knowledge of CMS regulations and resources available; and the ability to routinely apply this knowledge in the performance of job functions.
• Working knowledge of commercial payer, government payer, workers compensation, and liability insurance guidelines and resources; and the ability to routinely apply this knowledge in the performance of job functions.
• Intermediate proficiency in Microsoft Outlook, Microsoft Word, and Microsoft Excel.
• Advanced proficiency in navigating electronic computer systems and payer websites.
• Ability to communicate and work effectively with the public, community partners, and co-workers.
• Ability to manage job tasks, time, and resources appropriately.
  
  

Preferred Education, Licensure, and/or Experience:

• Experience working on revenue cycle improvement initiatives.
• Experience working in multiple areas within revenue cycle and/or other revenue generating departments.
  
  

Physical Requirements:

• Constantly operates a computer and other office equipment (phone, scanner, printer, copier, fax, etc.).
• Frequent work with digital and non-digital data requiring the ability to compare, detect, and assess accuracy of information in paper format and on the computer screen.
• Must be able to remain in a stationary position for extended periods of time (estimate at least 80%).
• Must be able to move throughout office, department location, main hospital campus, and off-site locations as needed to accomplish position objectives, and attend meetings and/or training.
• Must have adequate hearing to respond appropriately to phone, equipment, alarms, overhead codes, etc..
  
  

Environment & Working Conditions:

• Primarily indoors. Occasional travel/movement to and from off-site and on-campus locations, with potential exposure to adverse or extreme weather conditions. Must wear appropriate gear, clothing, and/or shoes.
• Occasional interaction with the public, including patients of all ages and diverse backgrounds, other visitors, EMS personnel, law enforcement officers, other community partners, and vendors.
• Minimal exposure to biohazardous materials. Must wear PPE in accordance with hospital policy for situation and area of hospital.
• Minimal risk of injury from moving parts or exposure to fumes and chemicals from copy machine toner, equipment, office supplies, & cleaning supplies.
• Frequent exposure to environmental noise created by people, doors, and equipment.
  
  

Remote Work Environment:

• Hybrid (combination of remote & in-person) work is available for this position upon approval.
• While working remotely, employees must comply with organizational policies, including ensuring a safe and private workspace that complies with all applicable state & federal regulatory guidelines.
  
  

Equal Opportunity Employer:

St. Joseph Regional Medical Center is committed to Equal Employment Opportunity and complies with all applicable laws prohibiting discrimination in employment because of color, race, gender, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veteran’s status and any other basis protected by applicable federal, state or local law.