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RCM Revenue Integrity Specialist

RCM Revenue Integrity Specialist

COMPANY DESCRIPTION

Unio Health Partners (UHP) is a highly differentiated physician practice management platform with the goal of transforming care delivery across the Western United States. UHP partners with leading physician practices, creating a cohesive, quality-oriented clinical culture and facilitating best practice sharing across the platform. Our affiliated practices gain access to a broader suite of services, providing a meaningful benefit to both physicians and patients. UHP's best-in-class clinical program covers three sub-specialties (urology, gastroenterology, and radiation oncology) and offers numerous ancillary services, including pathology lab, in-office dispensing, and chronic care management. We are led by a highly accomplished management team and provide a full suite of management services to its affiliated practices. UHP is currently affiliated with 182 providers consisting of 119 physicians and 63 advanced practice providers operating out of 54 locations across Southern, Central, and Northern California.

POSITION SUMMARY

The Revenue Integrity Specialist is responsible for ensuring accurate billing, coding, and reimbursement processes. They analyze claims, identify discrepancies, and implement solutions to optimize revenue capture while maintaining compliance and regulations. Communication with staff, payors, and patients is paramount in this position, ensuring that the patients and needs of all departments are met effectively and efficiently.

What you will be doing

Conduct pre and post payment audits on medical claims and coding submissions.
Review coding accuracy against clinical documentation and established guidelines.
Identify patterns of underbilling, overbilling or fraudulent billing practices.
Perform risk-based auditing to prioritize areas of highest concern.
Analyze billing data and identify trends and improvement opportunities.
Track KPI’s related to billing accuracy and revenue capture.
Oversee the financial processes related to patients care, including verifying insurance details, processing claims, and handling billing inquiries.
Follow-up on all assigned accounts from within the PM system in accordance with pre-established goals.
Research and analyze accounts and payments; reverse balances to credit or debit if charges were improperly billed or if payments were incorrect.

What you will bring to the team

High school diploma or GED certificate required.
4+ years of healthcare billing/ coding or AR and practical experience in healthcare setting.
Proficiency in using various software and/ or credentialing software and databases.
Knowledge of state and federal laws that apply to the duties of this position.
Microsoft Office Skills (Word, Excel, PowerPoint, Outlook).

What we can offer you

Competitive Salary and Health Benefits (Medical, Dental, Vision)
Generous time off (start accruing on your first day - no waiting period)
Paid Holidays
401(k)
Company Discounts
Collaborative work environment - we want our employees to have a say in how we run our office
Employee Recognition

Compensation is depending on a number of factors including a candidate’s qualifications, skills, competencies, or experience that may fall outside of the range shown

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