Revenue Integrity Specialist I

Nemours is seeking a Revenue Integrity Specialist to join our team.

This position Revenue Integrity Specialist is responsible for ensuring 100% facility charge capture 100% accuracy within Account, Charge Entry, Router and Claim Edit WQ's according to Billing/Payor regulations.

Secondary duties are to ensure "front end" UB-04 claims according to regulatory guidelines.

Works with payors, charge capture departments, compliance, CBO, and other areas of the Revenue Cycle at AIDHC.

Daily review of payor coverage updates and guidelines is essential.

Essential Functions:


* Reviews, monitors and completes hospital claims for all elements of the UBO4 billing form according to CMS and specific payor guidelines.


* Reviews daily DNB (Discharged Not Final Billed) accounts within assigned work queue(s).


* Works closely with Transport department and completes charge capture for Nemours Transport services.


* Assists in SP collections recovery, by calling guarantors and verifying insurance benefits.


* Provides support to scheduling and registration departments with patient coverage, eligibility and authorizations.


* Work assigned claim edit work queues correcting all errors and warnings to ensure first-time claim accuracy

Requirements:


* 1 year of specialized training beyond high school; high school diploma required


* CRCS- I certification within 12 months required


* 1 year of revenue cycle experience required


* Knowledge of Hospital Billing and Charge Capture


* Ability to function within EPIC and Hospital Billing Applications

About Us

Nemours Children's Health is an internationally recognized children's health system.

With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida.

Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals.

We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I.

DuPont Trust, as well as other income.

As one of the nation's premier pediatric health systems, we're on a journey to discover better ways of approaching children's health.

Putting as much focus on prevention as cures and working hand in hand with the community to make every child's world a place to thrive.

It's a journey that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention, leading to the healthiest generations of children ever.

Inclusion and belonging guide our growth and strategy.

We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment.

All of ...