Adeptus Health

Revenue Integrity Specialist

US-TX-Carrollton
1 week ago
Type
Regular Full-Time
Job ID
11339
Shift
Day
First Texas Carrollton - 401
Texas Health Hospital

Company Overview

Texas Health Hospital: Our mission is to provide the residents of Dallas/Fort Worth with increased access to the highest quality medical care. Texas Health Hospital is a beautiful full service community hospital featuring 50 inpatient beds, 10 ER treatment rooms, 3 Operating Rooms and a full digital imaging suite.

Responsibilities

Revenue Integrity Specialist (“RIS”) is responsible for reviewing medical records to determine whether documentation substantiates the medical necessity, quality of care, utilization, and coding of insurance claims. The RIS will ensure that data collected for reporting purposes from various departments is within charging practices and departmental policies. The RIS performs a variety of tasks in a fast-paced environment that require a high degree of skill, confidence, autonomy, and the ability to multi-task and prioritize effectively, and demonstrates excellent customer service skills, holding self and others accountable in meeting the Mission, Vision, and Goals of the Company.  This is a non-exempt positionReview remittance advices for denials and the appeal process, and finalizing department audit summaries

 

  • Ensure optimal billing methods that meet with billing compliance standards (regulations)
  • Acts as the first point of contact at the hospital for issues with claims reported by biller (holds)
  • Examine medical records to ensure that patient bills are correct and making sure that insurance claims comply with government regulations
  • Monitors and improves the quality of clinical and financial documentation related to the provision of patient services
  • Coordinates, finalizes and defends patient account audits, reviews documentation for lost charges, has demonstrated ability to write compelling and successful appeal letters
  • Compare clinical and financial records to ensure that the documentation provided supports the patient charges listed
  • Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care
  • Compile audit findings and formulate communication that conveys medical necessary services were ordered and provided warranting claim payment
  • Collaborate with multiple departments to prevent vulnerabilities
  • Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly
  • Share ideas that offer process improvements and train others team members, accordingly
  • Will conduct, coordinate, and notify medical records of external audits requested by outside agencies
  • Attendance requirements are based on your current role and status of position (FT, PT or PRN). Please direct attendance requirements to your immediate supervisor and/or refer to the Employee Handbook for more attendance/scheduling details/policies

Qualifications

  • Graduate of an accredited school of Professional Nursing
  • Current registration and licensure with the Board of Nurse Examiners for the state or a Compact state
  • 5 years of clinical practice
  • 2-5 years of auditing or medical review experience
  • Case Management and/or Utilization Review experience a plus
  • Experience in utilizing Interqual and/or E&M guidelines no less than 2 years
  • Familiar with CPT, ICD-9, ICD-10 and DRG coding
  • Well-developed verbal and written communication skills coupled with recognizable organization, and prioritization abilities

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