Nemours is seeking a Revenue Integrity Specialist to join our team.
This position Revenue Integrity Specialist is responsible for ensuring 100% facility charge capture 100% accuracy within Account, Charge Entry, Router and Claim Edit WQ’s according to Billing/Payor regulations. Secondary duties are to ensure “front end” UB-04 claims according to regulatory guidelines. Works with payors, charge capture departments, compliance, CBO, and other areas of the Revenue Cycle at AIDHC. Daily review of payor coverage updates and guidelines is essential.
Essential Functions:
Reviews, monitors and completes hospital claims for all elements of the UBO4 billing form according to CMS and specific payor guidelines.
Reviews daily DNB (Discharged Not Final Billed) accounts within assigned work queue(s).
Works closely with Transport department and completes charge capture for Nemours Transport services.
Assists in SP collections recovery, by calling guarantors and verifying insurance benefits.
Provides support to scheduling and registration departments with patient coverage, eligibility and authorizations.
Work assigned claim edit work queues correcting all errors and warnings to ensure first-time claim accuracy
Requirements:
1 year of specialized training beyond high school; high school diploma required
CRCS- I certification within 12 months required
1 year of revenue cycle experience required
Knowledge of Hospital Billing and Charge Capture
Ability to function within EPIC and Hospital Billing Applications
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This position Revenue Integrity Specialist is responsible for ensuring 100% facility charge capture 100% accuracy within Account, Charge Entry, Router and Claim Edit WQ’s according to Billing/Payor regulations. Secondary duties are to ensure “front end” UB-04 claims according to regulatory guidelines. Works with payors, charge capture departments, compliance, CBO, and other areas of the Revenue Cycle at AIDHC. Daily review of payor coverage updates and guidelines is essential.
Essential Functions:
Reviews, monitors and completes hospital claims for all elements of the UBO4 billing form according to CMS and specific payor guidelines.
Reviews daily DNB (Discharged Not Final Billed) accounts within assigned work queue(s).
Works closely with Transport department and completes charge capture for Nemours Transport services.
Assists in SP collections recovery, by calling guarantors and verifying insurance benefits.
Provides support to scheduling and registration departments with patient coverage, eligibility and authorizations.
Work assigned claim edit work queues correcting all errors and warnings to ensure first-time claim accuracy
Requirements:
1 year of specialized training beyond high school; high school diploma required
CRCS- I certification within 12 months required
1 year of revenue cycle experience required
Knowledge of Hospital Billing and Charge Capture
Ability to function within EPIC and Hospital Billing Applications
#J-18808-Ljbffr