United Surgical Partners International Inc (USPI)
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Revenue Integrity Specialist
at United Surgical Partners International Inc (USPI)
Baylor Scott & White Medical Center - Uptown is a new state of the art surgical hospital in the Dallas’ Uptown area. Specialties and services will include Orthopedic, Spine, Pain Management, General Plastic, and Ear, Nose and Throat surgery. Our mission is to provide first-class services for the local community in a safe, comfortable, and welcoming environment; one in which we would be happy to treat our own families.
Baylor Scott & White Medical Center - Uptown is a part of United Surgical Partners International (USPI). USPI owns and operates multiple surgical hospitals and ambulatory surgical care centers throughout the United States and London; with headquarter located in Addison, TX.
Baylor Scott & White Medical Center - Uptown is currently seeking a Revenue Integrity Specialist in the Business Office for Full Time opportunities. We are looking for a top-performer with solid knowledge of revenue cycle functions and denial resolution which primarily includes researching accounts, analyzing EOBs, and interacting with insurance companies for resolution of denied balances. Must be a hands-on problem solver and effective communicator to support the goals of the hospital Business Office.
Responsible for identifying the root cause of low or non-payments to achieve increased cash and a reduction in payer denials and overall bad debt accounts. Provide patient data to payers for resolution of denials due to medical necessity. The Specialist will also assist in identifying potential errors created as a result of incorrect claims processing, wrong eligibility records, late or missing provider submissions, and address payers’ questions to improve Hospital’s overall billing and reimbursement. This position will interact with Baylor Scott & White Medical Center - Uptown Business Office staff and the Central Services Organization (CSO) management and will report directly to the Business Office Manager at Baylor Scott & White Medical Center - Uptown.
- Perform research in Cerner and review EOBs for accounts identified as denied, underpayment, or “No-Status Available”
- Communicate with patients for coordination of benefits as needed to get claims processed
- Communicate with payers for re-submission of patient account data and coordinate with CSO as needed
- Perform root cause analysis on denials and work with appropriate Business Office and/or CSO staff to eliminate core problems causing denials.
- Prepare and send appeal letters with pertinent patient data for denials due to medical necessity
- Look at the “big picture” and review denials for potential trends by payer
- Monitor all overpayments (credits) to ensure they are processed timely after the appropriate Length of Time.
- Review all recouped accounts to determine reason for recoup
- Perform other A/R collection duties as assigned
- Solid understanding of Revenue Cycle functions and Business Office operations strongly preferred
- Excellent computer, proof reading, and attention to detail
- Excellent written and verbal communication skills
- Strong mathematical and analytical skills
- Strong customer service skills
- Ability to work independently, proactively with limited supervision and also as a team player when called upon
- Ability to work under pressure
- Ability to maintain the security of confidential information
- Two-year Associate's degree or equivalent experience required / Four-year Bachelor's degree or equivalent experience preferred
- 3 or more years of related experience desired (working Denied A/R and underpaid medical accounts)
- Progressive healthcare revenue cycle experience preferred
- Experience with Cerner preferred