Revenue Integrity Clinical Systems Specialist

Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It’s the way you want to be treated. Summary: Directly responsible for monitoring and analyzing charging policies and practices for all hospital departments and applying and communicating that knowledge to both clinical and non-clinical management in order to facilitate correct and compliant charging and optimize reimbursement.

Responsible for conducting and completing insurance audits through site visits by insurance auditors. Acts as a liaison and interpreter of clinical information as it relates to billing to patients, and all departments within Silver Cross Hospital. Analyzes and identifies breakdowns in processes that have financial impacts and coordinates appropriate work groups to resolve the issues.

Educates clinical and non-clinical staff on billing policies. Keeps up to date on reimbursement and denial trends. Works cooperatively with clinical leaders to develop and improve charge capture and documentation. Updates and maintains Charge master in collaboration with the clinical departments, Patient Accounts Management, Revenue Cycle Leadership, and Accounting.

Manage Managed Care Organization (MCO) authorized services to both the inpatient and outpatient population. Ensure correct coding providing feedback to billing and collection staff when questions arise. Appeal clinical denials, regardless of the denial source; appeals will be both verbal and written. Assist in obtaining authorizations for current inhouse patients.

Requirements

An Associate of Science Degree in a medically related field. Minimum of two years of previous experience in a Patient Accounting environment. Microsoft Excel – intermediate level of skill. Bachelor’s Degree in Accounting or Bachelors of Science in Nursing strongly preferred. Required License and/or Certification: a. If RN, current State of Illinois licensure b.

If coder, Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) Work Shift Details: Days, Days, Monday through Friday Department: PATIENT ACCOUNTS Benefits for You At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.

Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:

• Medical, Dental and Vision plans
• Life Insurance
• Flexible Spending Account
• Other voluntary benefit plans
• PTO and Sick time
• 401(k) plan with a match
• Wellness program
• Tuition Reimbursement Registry employees who meet eligibility may participate in our 401(k) Savings plan with a potential match. However, registry employees are ineligible for Health and Welfare benefits. The expected pay for this position is listed below: $25.84 - $32.30 The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.