Revenue Integrity Specialist

About Us

Xtensys, a recently established managed service provider, delivers cutting-edge technology to health systems, starting in NY and expanding beyond. Owned by two industry leaders focused on innovation in rural and community health, we are rapidly growing with several major initiatives underway.

Job Summary

The Revenue Integrity Specialist is responsible for performing and implementing charge capture and process improvement initiatives to optimize performance and improve revenue management. This position is also responsible for managing charge edits, conducting root cause analysis, developing corrective action plans, educating internal customers, and monitoring results. This position will collaborate with the entire Revenue Integrity Team to operationalize our clients Revenue Integrity strategy and plan for improving revenue results across all departments.

Duties/Responsibilities

• Acts as subject matter expert for all questions concerning charging and charge reconciliation.
• Determines and executes the best approach for timely resolution of accounts with edits.
• Responsible for accuracy and compliance of accounts in terms of charge edits.
• Possesses a working knowledge of institutional and professional claim forms.
• Enters appropriate information into patient accounting system to ensure accurate account documentation.
• Maintains current knowledge of Federal, State and Managed Care billing methodologies, rules and regulations.
• Understands hospital charge capture process and compliance issues and has the ability to provide resolution by performing research, utilizing third party payor regulations, referencing billing guidelines and CMS guidelines.
• Identifies root cause of issues related to charge edits and coordinates efforts with hospital departments to minimize recurring edits related to billing and registration.
• Identifies automation opportunities
• Meets performance, productivity and quality goals metrics
• Attends and participates in department staff meetings and other meetings as assigned
• Responsible for escalating issues and trends to Revenue Integrity Director.
• Special projects as assigned
  
  

Required Skills/Abilities

• Minimum of high school diploma/GED with 5 years’ revenue cycle experience 2 of them in a Revenue Integrity Role or
• Associate's degree with 2 years’ Revenue Cycle Experience
  
  

Experience

• Minimum of five (5) years’ billing, coding, or revenue cycle experience in an institutional setting.
• Medical terminology with working knowledge of ICD-10, CPT and HCPCS codes.
• Experience using Microsoft Office suite including Word and Excel.
• Professional Coding or Billing experience is a plus.
• Epic experience a plus.
  
  

Licensure

• Billing or coding certification preferred
  
  

Physical Requirements

• Lifting up to 20 pounds, standing or sitting for extended periods of time, as well as repetitive use of hands and fingers.