Revenue Integrity Training Specialist

JOB SUMMARY: The Revenue Integrity Training Specialist is responsible for developing and delivering training programs that enhance staff proficiency in core RCM functions including insurance verification, authorization workflows, Electronic Medical Record (EMR) system usage, hospice room and board tracking, and AR collections. This role supports business office operations by ensuring accurate documentation, timely billing, and compliance with payer requirements, while driving continuous improvement through audits and feedback.

ESSENTIAL JOB FUNCTIONS:

• Develop and deliver training on RCM processes including insurance verification, authorizations, and billing workflows
• Train staff in accurate documentation and monthly reconciliation of hospice room and board charges
• Conduct audits and provide feedback to improve billing accuracy and compliance
• Support AR collections by training staff on best practices and resolving discrepancies
• Collaborate with Executive Directors and Business Office teams to optimize workflows
• Maintain training documentation and provide ongoing support and refresher sessions
• Monitor staff performance and address knowledge gaps through targeted training.
• Training Development and Delivery:
  • Design, develop, and deliver training programs related to Medicaid eligibility verification, EMR attributes, hospice room and board tracking, AR collections, and other key administrative processes.
  • Create instructional materials, including training guides, presentations, checklists, and online resources to ensure clarity and ease of learning.
  • Conduct both in-person and virtual training sessions for new and existing staff, ensuring proficiency in eligibility processes, Medicaid authorizations, and use of the EMR system.
• Medicaid Authorization and Eligibility Training:
  • Educate staff on the process for verifying Medicaid eligibility, including how to navigate insurance portals and communicate with providers.
  • Train team members on how to accurately submit Medicaid authorizations and ensure timely follow-up on pending authorizations.
  • Ensure that staff understand the process for tracking and reviewing hospice room and board charges, and how to input and monitor this information accurately.
• EMR System Training:
  • Provide hands-on training in the EMR system, focusing on the maintenance of patient attributes, eligibility data entry, and accurate reporting.
  • Work with Informatics in developing user-friendly tutorials and troubleshooting guides to support staff in using the EMR system effectively.
  • Conduct refresher courses to keep staff updated on any system changes or new features that impact on their work.
• Room and Board Auditing and Training:
  • Room and Board Forms: Provide training on the proper completion and submission of room and board forms for hospice patients, ensuring compliance with internal protocols and payer requirements.
  • Room and Board Checklist: Develop and implement a monthly room and board checklist for staff to follow, ensuring all required information is accurately captured and reviewed.
  • Room and Board Audits: Conduct regular audits on room and board forms to ensure that they are completed correctly, that billing is accurate, and that no discrepancies exist between submitted forms and patient records.
  • Continuous Improvement: Review audit results with staff, providing feedback and additional training where necessary to improve accuracy and efficiency in room and board billing.
  • Month-End Processes and Compliance:
    • Train staff on month-end procedures for reviewing and signing off on eligibility, authorizations, and hospice charges to ensure all steps are completed accurately and on time.
    • Ensure that staff is familiar with compliance requirements and documentation standards, including HIPAA and Medicaid-specific regulations.
    • Guide staff in performing month-end reconciliations, ensuring all necessary documentation is submitted and processed by the deadline.
  • Ongoing Support and Troubleshooting:
    • Provide ongoing support and guidance to staff as they apply their training to daily tasks, including answering questions and resolving issues.
    • Monitor staff performance and provide feedback to ensure adherence to processes and protocols.
    • Identify knowledge gaps and conduct additional training sessions to address specific areas of need.
  • Collaboration and Feedback:
    • Work closely with the Executive Directors and Business Office teams to identify areas for improvement in processes and staff training.
    • Gather feedback from staff and leadership to refine training programs and enhance the learning experience.
    • Help improve the overall efficiency of business office operations by identifying opportunities for process optimization.
  • AR Collections Support:
    • Assist branch-level staff in resolving Accounts Receivable (AR) issues related to Medicaid authorizations, eligibility verification, and hospice billing discrepancies.
    • Provide training and guidance on AR best practices, including following up on outstanding balances, reviewing aging reports, and working with the finance team to identify resolution strategies.
    • Collaborate with branch managers and the finance department to address AR challenges, ensuring the timely collection of payments and reducing outstanding receivables.
    • Monitor the AR process to identify patterns of issues and provide targeted training to prevent recurring problems.

REQUIRED EDUCATION & EXPERIENCE:

• Must be at least 18 years of age
• Experience as a trainer or educator in a healthcare setting
• Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred
• Familiarity with Medicaid and insurance provider regulations in healthcare

REQUIRED KNOWLEDGE, SKILLS & ABILITIES:

• Strong understanding of RCM workflows including insurance verification, authorizations, and billing.
• Strong background in training or teaching, with the ability to communicate complex concepts clearly
• Proficiency in Hospice EMR’s systems or similar healthcare management software
• Exceptional organizational skills and ability to manage multiple training sessions simultaneously
• Strong presentation and instructional skills, with experience in both virtual and in-person training environments
• Knowledge of hospice care operations, billing processes, AR collections, and regulatory requirements
• Ability to work effectively with diverse teams and create an engaging learning environment

OTHER REQUIREMENTS:

• Ability to travel up to 75% as needed
• Flexible work schedule to accommodate training and audits
• Must pass background check and comply with company policies

WORK ENVIRONMENT:

• Must comply with company policies, procedures and processes in addition to Hospice and Homecare rules and regulations
• Must be dependable and flexible in work schedule
• Foster collaborative and professional relationships across departments
• Participate in audits, surveys, and system implementations as needed

PHYSICAL ENVIRONMENT:

• Must be able to use standard office equipment including, but not limited to, computers, copiers, scanners and fax machines
• Must be able to sit for long periods
• Must be flexible to work remotely and in the office.
• Must be able to communicate verbally by phone or in person
• Requires consistent wrist movement and exposure to computer screens