Job Details

University of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family. The primary site of inpatient care services is at the University of Toledo Medical Center, but many of our physicians' practice at hospitals and medical offices throughout the region.

University of Toledo Physicians offers competitive pay and benefits including: 403B, Pension, health and tuition waiver at UT.

POSITION SUMMARY

The Revenue Integrity Analyst performs advanced level work related to denial management. This position is responsible for conducting comprehensive reviews and management of denials. The Revenue Integrity Analyst will actively manage, maintain, and communicate denial/appeal activity to appropriate stakeholders and report suspected/emerging trends to revenue cycle leadership. This individual will work independently to plan and organize efforts that directly impact reimbursement and reduce denials.

ESSENTIAL JOB FUNCTIONS AND ACCOUNTABILITIES

1. Research and identify trends in payer denials.
2. Identify denial patterns and escalate to management as appropriate with sufficient information for follow up.
3. Make recommendations for additions/ revisions to work queues, claim edits and potentially workflows to improve efficiency and reduce denials.
4. Review payer communications to identify potential reimbursement related concerns; escalate potential issues to appropriate parties such as but not limited to patient access, clinical staff, managed care department, revenue cycle leadership, etc.
5. Identify opportunities for process improvement and actively participate in completing these initiatives.
6. Will provide training and education as needed related to reducing denial volume.
7. Will maintain current knowledge of regulations and payer policies.
8. All other duties as assigned

REQUIRED QUALIFICATIONS

• Education: High-school diploma or equivalent
• Skills:
  • Demonstrated ability to work independently
  • Excellent communication and interpersonal skills.
  • Strong organizational and task management skills.
  • Strong critical thinking and analytical skills
  • Proficient in Microsoft Office products.
  • Ability to navigate shifting workflows and priorities.
  • Ability to work collaboratively in a team-oriented environment, courteous and friendly demeanor.
  • Ability to exercise sound judgment and problem-solving skills.
  • Ability to handle patient and organizational information in a confidential manner.
  • Basic understanding of insurance requirements and regulations contract benefits, and credit/collection procedures.
  • Epic Experience

Work Experience

• 4+ years' experience in resolving insurance denials, coding, and/or revenue cycle.
• Experience with medical and insurance terminology

Preferred QUALIFICATIONS

• Education: Associate degree

WORKING CONDITIONS

• Works in a professional office environment that is well lit and well ventilated; and the equipment and materials needed to perform job duties are supplied.

The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

Equal Opportunity Employer/Drug-Free Workplace