Revenue Integrity Specialist I

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Investigate denials or audits from all commercial and governmental payors

• Conduct compliance reviews of payors on accounts to assess medical necessity both prior to and following service, as well as before and after billing

• Acquire predeterminations, prior authorizations, and retro authorizations as mandated by the payor

• Address account reviews to secure reimbursement, recover outstanding revenue, and avert future revenue loss

• Adhere to the timelines established by payors and government entities

• Implement recovery efforts utilizing written correspondence, email, websites, and telephone communication

⛳️ Requirements

• Bachelor’s Degree in a relevant field, Practical Nurse License, or Coding Certification accompanied by two years of experience in healthcare

• Alternatively, five years of healthcare experience is required, including two years in a revenue cycle-related area such as registration, patient financial services, or managed care

• Familiarity with medical terminology

• Understanding of payor reimbursement guidelines, including authorization/notification, medical necessity, and timely filing regulations

• Knowledge of processes for appealing payor denials and resolving payment variances

• Awareness of managed care contracts

• Strong understanding of audit response requirements and associated timelines

🏝️ Benefits

• Competitive salary and performance-based incentives

• Comprehensive health, dental, and vision insurance

• Generous paid time off and holiday schedule

• Opportunities for professional development and continuing education