RESEARCH REVENUE INTEGRITY SPECIALIST - RESEARCH at Saint Bernards Medical Center – JONESBORO, Arkansas

Education

Associates Degree and/or related experience.

Experience

Requires 2 - 5 years of healthcare experience preferably with knowledge of the reimbursement/denials process. Should have knowledge of ICD 10 & CPT coding and guidelines. Knowledge of reimbursement systems, Federal, State and payor-specific regulations pertaining to documentation and billing. Requires coding, billing (UB-04 requirements), possesses process management, leadership and interpersonal skills. Requires excellent written and verbal communication skills. Must be proficient in Excel spreadsheet, word processing and database applications. Must be able to act independently. Documented results in getting desired results. Must have meticulous follow-up skills. Must have had experience in working in a team environment.

Physical

This is a safety sensitive position. Please see the St. Bernards Substance Abuse Policy for further information.

Normal hospital environment. Close eye work and hearing within normal range. Oral communication. Operates computer, fax and copier. Long periods of sitting. Occasional walking, bending, and climbing. May lift, carry, push and pull up to 5 pounds.

JOB SUMMARY

Responsible for accurate and timely preparation of claims to third party payers for assigned patients enrolled in clinical trial research studies. The position is also responsible for accurately coding research patient accounts and coordinating related inter-departmental communications. Responsible for aggregating and trending denials information according to discrete OP denial codes and work within denial software. Close out each tracked denial (overturned or recouped). Overall works to increase revenue capture. Analyzes information, assigns follow-up responsibility. In addition, maintains oversight of protocol driven encounters to ensure they are charged correctly to the patient’s insurance or the research department. Facility resource for billing, denials process and regulatory compliance, as it relates to clinical trial research. Ability to manage competing priorities, multi-task with results oriented outcomes and work in a fast paced environment. This position is required to utilize independent judgment and critical thinking skills. Over the course of employment it is expected that this position will become knowledgeable about the clinical trial research process and be able to effectively manage the effects clinical trials have compliance, coding and billing.