Revenue Integrity Specialist I

Summary

Job Description:

Baptist Health is looking for a Revenue Integrity Specialist I to join our team! This is a remote work position that requires residency in KY or IN

Research denials or audits from all commercial and governmental payors. Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains predeterminations, prior authorizations, and retro authorizations when required by 
payor. Responds to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines. Recovery efforts include but are not limited to written letter, email, web site, and telephonic communication.

Qualifications:

• Bachelor’s Degree in related field, Practical Nurse License, or Coding Certification with two years of healthcare experience

• In lieu of Bachelor’s degree, five years of healthcare experience required including two years in a revenue cycle related area such as registration, patient financial services, or managed care.

• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts. 

• Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines