Job Description: Research denials from all commercial and governmental payors, including pre-denial audits performed by UPICs or similar entities. 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. Actively seeks opportunities to positively impact Revenue Integrity workflows and metrics, utilizing experience to identify process improvement needs and to design and implement best practices. Works independently with other departments / physician offices to adapt best practices to changing needs within the local or broader healthcare environment. Escalates issues to Supervisor and Manager when a department is not responsive to suggestions for preventing revenue loss. Bachelor’s Degree in a related field, Practical Nurse License, or Coding Certification with at least five years healthcare experience, two of which must be in a revenue cycle related area such as registration, patient accounting, financial services, or managed care. In lieu of Bachelor’s degree, eight years of healthcare experience required with at least five of those in a revenue cycle related area as listed above. Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal resolution processes; and managed care contracts. Individuals working with government audits must have a keen understanding of all audit response requirements and timelines. If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now! Employees will be expected to comply with Baptist Health’s infectious disease and vaccination policies, which include but may not be limited to compliance with BHS’ mandatory vaccination policies for influenza and COVID unless reasonable accommodations are needed under applicable law Baptist Health is an Equal Employment Opportunity employer.