Revenue Integrity Specialist

Revenue Integrity Specialist

UnityPoint Health – Black Hawk Grundy Mental Health Center

Shift: Full-time 40 hr./wk.; M-F; 8 am – 430 pm

Benefits Eligible

The Revenue Cycle Integrity Specialist works for BHGMHC in concert with the Waterloo Region Finance Team and the Revenue Integrity Department and Central Billing Office. This position is responsible for working work queues, identifying trends, and collaboratively working with other BH entities to improve the revenue cycle performance within the region/system within UnityPoint Health. This position requires strong decision-making ability around charging issues, complex claims processing workflows and regulations that requires utilization of data coming from multiple resources. To evaluate charging and billing issues appropriately, Specialists will need to understand the entire Revenue Cycle. This role will have ongoing interaction with leadership, revenue cycle staff, coding staff, billing staff, and IT teams.

This individual will focus on supporting continuous improvement in key revenue cycle functions including Registration, Coding, and Billing. The Specialist will maintain a good working relationship with all affiliates to ensure clear communication and a collaborative approach to implementing best practice processes.

Why UnityPoint Health? 

• Commitment to our Team – We’ve been named a  Top 150 Place to Work in Healthcare 2022  by Becker’s Healthcare for our commitment to our team members. 
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience  a culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve. 
• Benefits – Our competitive  Total Rewards  program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. 
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation. 
• Development – We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience. 
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve. 

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.  https://dayinthelife.unitypoint.org/  

• Work the work ques assigned to BHGMHC to ensure clinical services are complete prior to submission to payor.
• Work with BHGMHC administrative and clinical staff to ensure clinical documentation supports the level of service (CPT, E&M Codes) being billed.
• Resolve billing errors/edits, charge review edits and claim edits including accounts with Stop Bills and “DNBs” to ensure all claims are filed in a timely manner.
• Provide timely feedback to management of identified charging issues within departments, claims issues, repetitive errors, and payer trends to expedite claims adjudication.
• Work accounts in assigned queues in accordance with departmental guidelines.
• Assists with analyzing data to identify opportunities for process improvement. Assist with development of reporting that will create accountability and drive change.
• Assists with critical Revenue Cycle projects by collaborating with key stakeholders across the UPH Behavioral Health Service Line. These projects affect business operations to a substantial degree.
• Assists with collection, monitoring and analyzing data, and gives feedback to management for recommendations to leadership to drive better performance throughout the revenue cycle.
• Provides expert consultation to leadership as the subject matter expert for revenue cycle data
• Interprets existing revenue cycle policies and operating practices to make recommendations for improvements.
• Identifies different types of data that require tracking to improve revenue cycle performance.
• Provide timely feedback to management of identified charging issues, repetitive errors, and payer trends to expedite claims adjudication.
• Work with BHGMHC Administrative staff, Waterloo Region Finance staff, Revenue Integrity staff, Central Billing Office staff and BHSL leaders to prioritize suggested changes.
• Provides training as needed to improve operations.
• Work with Revenue Integrity and CBO staff to resolve claim denials.
• Assist with reports that track performance and are easy-to-interpret.
• Develop an understanding of complex rules and regulations governing insurance, appeal activities, trends, etc. and make recommendations on system build to accommodate changes in these areas.
• Develop an understanding of the entire revenue cycle and the factors that lead to denials and revenue loss.

• High School Diploma required. AA or BA in Healthcare Administration, Business, Mathematics, or Computer Science preferred.
• 1-2 years in healthcare, specifically behavioral health billing.
• Strong skills including professionalism, interpersonal skills, ability to communicate effectively through written and verbal methods, process improvement skills.
• Working knowledge of Epic and Microsoft office programs. Ability to manipulate large amounts of data.