Revenue Integrity Specialist I

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🔥 0 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Baptist Health System KY & IN

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1924

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Baptist Health System KY & IN is a comprehensive healthcare provider operating in Kentucky and Southern Indiana. It offers a wide range of services such as behavioral health, cancer care, gastroenterology, heart care, imaging and diagnostics, and specialized care for mother and baby, neurology, stroke, orthopedics, and sports medicine. The system provides various types of care including emergency, urgent, and virtual care, and supports digital health through their MyChart app. Baptist Health is committed to community health through outreach programs, education, and research, and emphasizes patient safety and quality care across its numerous locations. It offers extensive career opportunities in healthcare and strives for transparency and patient-centered care.

📋 Description

• Research denials or audits from all commercial and governmental payors • Perform payor compliance reviews on accounts to determine medical necessity before and after service and before and after billing • Obtain predeterminations, prior authorizations, and retro authorizations when required by payor • Respond to account reviews to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss • Meet appropriate payor and government timelines • Conduct recovery efforts through written letters, email, websites, and telephone communication

🎯 Requirements

• Bachelor’s Degree in related field, Practical Nurse License, or Coding Certification with two years of healthcare experience • In lieu of Bachelor’s degree, five years of healthcare experience required including two years in a revenue cycle related area such as registration, patient financial services, or managed care • Knowledge of medical terminology • Knowledge of payor reimbursement guidelines, including authorization/notification, medical necessity, and timely filing guidelines • Knowledge of payor denial appeal/payment variance resolution processes • Knowledge of managed care contracts • Keen understanding of audit response requirements and timelines