Revenue Integrity Assistant at Memorial Health Care Center – Owosso, Michigan

JOB SUMMARY

Under general supervision of the Manager, the Revenue Integrity Assistant is responsible for maintaining payer contract documentation, organizing fee schedules, and monitoring payer policy updates. This role supports revenue cycle operations by ensuring reimbursement and contract terms are accurately documented within internal revenue integrity systems and appropriately maintained within the organization’s external patient estimate platform, while reviewing accounts to confirm payments align with contracted rates and payer policies. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

PRIMARY JOB RESPONSIBILITIES

1. Maintain and organize payer contracts, amendments, and related documentation in electronic contract management system.
2. Maintain and update payer fee schedules within internal and external systems
3. Maintain Kodiak RCM mapping updates and file downloads daily
4. Monitor payer communications and policy updates, and communicate relevant changes to internal teams
5. Review accounts to verify payments are consistent with payer contracts and reimbursement policies
6. Review accounts to verify payments align with expected reimbursement rates for new services lines
7. Maintain documentation and reference material related to payer policies and contract terms
8. Annual update clinic reference material with updated pricing for the new year including self-pay pricing and client pricing.
9. Annual update to insurance payers regarding pricing increases
10. Retrieve and compile data for recurring daily, weekly, and monthly reports to support organizational reporting and communication needs
11. Review, track and process single case agreements with non-contracted payers as needed
12. Communicate payer/billing concerns to PFS leadership staff.
13. Work with Revenue Integrity Analyst and CMH payers to update contracts and negotiate new rates annually.
14. Understand and maintain pricing transparency file requirements and work with outside vendor to maintain reporting in accordance with CMS requirements.
15. Provide administrative support to AVP of Finance as requested by assisting with calendar management, meeting schedule, document preparation for meetings.
16. Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.

DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES

1. Other duties as assigned

JOB SPECIFICATIONS

EDUCATION

1. Associates Degree preferred or in lieu of degree, 5+ years of relevant experience required.

EXPERIENCE

1. Two (2) to five (5) years’ experience with professional and/or facility insurance billing.
2. Ability to prioritize workload; demonstrated organization and problem-solving skills. Ability to work independently.
3. Knowledge of various health insurance payments structures, DRG, fee schedules, EOB, 835/837, UB-04, CMS-150, CPT/HCPC
4. Working knowledge of Hospital billing systems preferred
5. Demonstrate proficiency with Microsoft Word, and advanced level experience in Microsoft Excel.

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

1. Able to travel independently throughout all Memorial Healthcare facilities.
2. Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).

ESSENTIAL TECHNICAL ABILITIES

1. Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.

ESSENTIAL MENTAL ABILITIES

1. Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
2. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.

ESSENTIAL SENSORY REQUIREMENTS

1. Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
2. Able to hear for work-related purposes.

INTERPERSONAL SKILLS

1. Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.
2. Required to remain calm when adversity is encountered.
3. Open, honest, and tactful communication skills.
4. Ability to work as a team member in all activities.
5. Positive, cooperative and motivated attitude.