Revenue Integrity Technician
Company: Sovah Health - Martinsville
Location: Martinsville
Posted on: October 17, 2024
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Job Description:
Position Summary -Sovah Health is looking for the ideal
candidate who will coordinate, evaluate and measure 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. - - - - - - -
- - - 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. -Who We Are:People are our passion and
purpose. - Come work where you are appreciated for who you are not
just what you can do. Licensed for 220 beds, SOVAH Health -
Martinsville, is a full service, acute-care hospital providing over
22 medical specialties. Among the services we offer are a home
health & hospice agency, advanced wound healing center, cardiac
rehabilitation center, two cardiac catheterization labs, and
medical & radiation oncology services.Where We Are:In Martinsville,
explore culture and arts, enjoy kayaking or hiking and so much more
in the foothills of the Blue Ridge Mountains. From the river to the
racetrack, we offer plenty of activities to guarantee that you and
your family have a fun filled time! -Why Choose Us: - - - - - - - -
- Health (Medical, Dental, Vision) and 401K Benefits for full-time
employees - - - - - - - - - Competitive Paid Time Off / Extended
Illness Bank package for full-time employees - - - - - - - - -
Employee Assistance Program - mental, physical, and financial
wellness assistance - - - - - - - - - Tuition
Reimbursement/Assistance for qualified applicants - - - - - - - - -
Professional development, Growth opportunities, and Mentor-based
training - - - - - - - - - And much more---Minimum
Qualifications:Minimum EducationHigh school diploma or equivalent
Required. College education or 2 years' experience
preferred.Required SkillsRequires critical thinking skills,
decisive judgment and the ability to work with minimal supervision.
Must be able to work in a stressful environment and take
appropriate action.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.Typical Physical Demands: 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.Minimum
Work ExperienceTwo 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. -EEOC Statement:SOVAH Health
- Martinsville 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.Equal
opportunity and affirmative action employers and are looking for
diversity in candidates for employment:
Minority/Female/Disabled/Protected Veteran
Keywords: Sovah Health - Martinsville, Danville , Revenue Integrity Technician, Professions , Martinsville, Virginia
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