Quorum Health
Revenue Integrity Specialist
Full-Time Remote Position
Monday - Friday
General Summary:
The Revenue Cycle Analyst provides analytic support, claims resolution, problem‑solving, and communication with clinic departments on all matters pertaining to revenue cycle needs.
Duties and Responsibilities
Responsible for analyzing and presenting data in coordination with clinical and financial management goals, benchmarks, and objectives in assigned areas
Complies daily with departmental policies and procedures
Support and assist Hospital and Physician team members with difficult issues concerning work, clients and/or insurance carriers; offer suggestions to assist in process of underpayment reviews and collections
Resolves claims processing issues with commercial and governmental payers and provide all required information timely; involves patients and family members (where necessary) to ensure timely resolution of claims with insurance companies
Responsible for making sure the facilities understand the standard charging guidelines and how to correct charge errors going forward
Resubmits clean and accurate claims to insurance companies in a timely and compliant manner
Researches, prepares, and submits appeals to insurance companies
Details all actions taken on account with clear and concise notes
Monitors and recognizes denials and/or issues that may be trends and escalates to supervisor as needed
Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations
Perform various monitoring tasks that identify revenue integrity opportunities
Working knowledge of Athena
Works closely with Department management to facilitate root issue remediation
Complete claims resolutions timely, accurately while meeting department benchmarks
Present data, analysis, and recommendations for solutions in meetings with departmental management
Reviews and analyzes “Explanation of Benefits” (EOBs), payer correspondences to identify denials that can be appealed. Perform denials analysis to reduce controllable rejections
Perform deep‑dive analysis to find solutions that can benefit multiple specialties
Performs other duties as assigned
Knowledge, Skills and Abilities
Knowledge of basic medical coding/terminology and commercial/government insurance operating procedures and practices
Understands payer guidelines related to effective claim resolution
Knowledgeable and proficient with payer websites and other useful resources; Knowledge of revenue cycle and/or business office procedures
Highly detail oriented and organized
Ability to read, understand, and follow oral and written instructions
Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Quorum Health Systems
Strong verbal and written communication skills
Ability to work independently and follow-through and handle multiple tasks simultaneously
Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self‑pay reimbursement concepts and overall operational impact
Demonstrated advanced skills in A/R management, problem assessment, and resolution, and collaborative problem‑solving in complex, interdisciplinary settings
Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution
Advanced skills in using excel to maneuver through large volumes of data
Work Experience, Education and Certifications
Education – High School Diploma or equivalent
5+ years in relevant Healthcare experience
Travel Requirements
Travel is infrequent
This job description is not to be construed as a complete listing of the duties and responsibilities that may be given to any employee. The duties and responsibilities outlined in this position may be added to or changed when deemed appropriate and necessary by the person who is managerially responsible for this position.
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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General Summary:
The Revenue Cycle Analyst provides analytic support, claims resolution, problem‑solving, and communication with clinic departments on all matters pertaining to revenue cycle needs.
Duties and Responsibilities
Responsible for analyzing and presenting data in coordination with clinical and financial management goals, benchmarks, and objectives in assigned areas
Complies daily with departmental policies and procedures
Support and assist Hospital and Physician team members with difficult issues concerning work, clients and/or insurance carriers; offer suggestions to assist in process of underpayment reviews and collections
Resolves claims processing issues with commercial and governmental payers and provide all required information timely; involves patients and family members (where necessary) to ensure timely resolution of claims with insurance companies
Responsible for making sure the facilities understand the standard charging guidelines and how to correct charge errors going forward
Resubmits clean and accurate claims to insurance companies in a timely and compliant manner
Researches, prepares, and submits appeals to insurance companies
Details all actions taken on account with clear and concise notes
Monitors and recognizes denials and/or issues that may be trends and escalates to supervisor as needed
Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations
Perform various monitoring tasks that identify revenue integrity opportunities
Working knowledge of Athena
Works closely with Department management to facilitate root issue remediation
Complete claims resolutions timely, accurately while meeting department benchmarks
Present data, analysis, and recommendations for solutions in meetings with departmental management
Reviews and analyzes “Explanation of Benefits” (EOBs), payer correspondences to identify denials that can be appealed. Perform denials analysis to reduce controllable rejections
Perform deep‑dive analysis to find solutions that can benefit multiple specialties
Performs other duties as assigned
Knowledge, Skills and Abilities
Knowledge of basic medical coding/terminology and commercial/government insurance operating procedures and practices
Understands payer guidelines related to effective claim resolution
Knowledgeable and proficient with payer websites and other useful resources; Knowledge of revenue cycle and/or business office procedures
Highly detail oriented and organized
Ability to read, understand, and follow oral and written instructions
Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Quorum Health Systems
Strong verbal and written communication skills
Ability to work independently and follow-through and handle multiple tasks simultaneously
Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self‑pay reimbursement concepts and overall operational impact
Demonstrated advanced skills in A/R management, problem assessment, and resolution, and collaborative problem‑solving in complex, interdisciplinary settings
Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution
Advanced skills in using excel to maneuver through large volumes of data
Work Experience, Education and Certifications
Education – High School Diploma or equivalent
5+ years in relevant Healthcare experience
Travel Requirements
Travel is infrequent
This job description is not to be construed as a complete listing of the duties and responsibilities that may be given to any employee. The duties and responsibilities outlined in this position may be added to or changed when deemed appropriate and necessary by the person who is managerially responsible for this position.
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr