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Revenue Integrity Auditor

Company: All Children's Hospital
Location: Saint Petersburg
Posted on: October 13, 2019

Job Description:

Revenue Integrity Auditor Requisition #: 184920
Location: Johns Hopkins All Children's Hospital, St. Petersburg, FL 33701
Category: Finance
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Aug. 19, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
POSITION SUMMARY:
Identifies opportunities to capture lost revenue through rebilling or reprocessing of underpaid claims. The Revenue Integrity Auditor is responsible for ensuring that additional reimbursement is captured and processes are put in place to correct future revenue leakage.
KEY ACCOUNTABILITIES:

  • Reviews claims to determine if payment was appropriate, and if not, reports to payers and/or reopens projects to ensure all underpaid claims are reprocessed and paid correctly
  • Develops and manages revenue integrity and revenue recovery projects in a timely manner, including documenting progress, analyzing trends and identifying opportunity for procedure creation or improvement
  • Performs, coordinates and supports all activities necessary to ensure appropriate payments and adjustments are performed on impacted accounts
  • Monitors revenue leakage to identify root causes to develop, implement and operationalize solutions to resolve and prevent these issues, and as needed, work directly with departments to put these solutions in place
  • Provides support to various revenue cycle projects and implementations to ensure success QUALIFICATIONS:
  • High School Diploma/GED
  • 5 years of hospital and/or physician collections experience with two years' experience auditing claims and managing revenue recovery projects, to include physician / hospital billing (CPT, HCPCS, and ICD-10), payer reimbursements and contract language
  • Comprehensive understanding of payer operations and medical contract reimbursement terms & guidelines, as well as reimbursement methodologies used by Medicare, Medicaid and Commercial payers
  • Proficient in Microsoft Office applications, particularly Excel
  • Current Florida Driver's license with clean driving record PHYSICAL DEMANDS:
    • __X__ Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
    • __X__ Category 2: Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties WORK ENVIRONMENT:
      • Climate controlled office setting
      • Occasional movement throughout any and all areas of the hospital campus including Specialty Care Centers, Therapy Centers and other off campus locations Johns Hopkins Health System and its affiliates are drug-free workplace employers.

        Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

        Company Description:

        All Children's Hospital provides expert pediatric care for children and families from all across the state of Florida and beyond. Named a top 50 children's hospital by U.S. News & World Report,--we provide compassionate, state-of-the-art care for infants, children and teens with some of the most challenging medical problems. We are a 259-bed pediatric hospital.--

Keywords: All Children's Hospital, St. Petersburg , Revenue Integrity Auditor, Other , Saint Petersburg, Florida

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