|Employer:||SSM Health System
|Skills:||Epic,Audits,RI Audit,Revenue Cycle Support,
|Specialties:||Clinical and Non Clinical Departments
|Required Certifications:||• Bachelor’s degree in healthcare or related field. • At least 5 years of experience in healthcare finance/revenue cycle and effectively working with multiple,diverse stakeholders in a complex hospital organization.
|Preferred Certifications:||• Familiarity with multiple Epic systems modules (i.e.,Resolute,• Continuous Quality Improvement training and experience leading quality improvement teams.,Cadence,Prelude)
|Required Experience:||3 to 4 years
|Preferred Experience:||5 to 7 years
|Location:||St Louis, MO
The Revenue Integrity Lead supports the SSM Health St. Louis network revenue cycle goals through data analysis, auditing, education and training, compliance monitoring, and process improvement of revenue cycle functions. Serves as a resource for all Health Ministry coworkers, clinical/non clinical, and coding to ensure revenue integrity and entitlement.
The Lead position for Revenue Integrity Audit works in partnership with clinical and non-clinical departments, Epic IHT, and across SSM Health Ministries and affiliates. The Lead position is a liaison between the RI Audit Director and Revenue Integrity Analytic Specialist team. Working relationships must be established and productively maintained with operational department managers and senior leaders in key customer groups.
• Improve the overall patient care experience by providing revenue cycle support to all departments across the SSMH St. Louis Network.
• Educate new team leaders & departments about charge capture/reconciliation.
• Contributes to the overall employee satisfaction of the department by actively participating in assigned meetings and offering assistance to others as needed.
• Understands, embraces and models the SSMH exceptional service standards.
• Ensures SSMH billing guidelines are compliant with governmental, and commercial payer regulations for claim presentation based on documentation, charging, billing, and reimbursement processes.
• Maximizes the efficiency of revenue cycle operations by analyzing data, identifying opportunities, and assisting with training, education, and implementation of improved processes.
• Enhances net revenue by performing audits to identify and capture all entitled revenue.
• Root cause analysis of charging issues, billing issues for denials and underpayments for improvement opportunities.
• Increases accurate claim submission by reviewing, researching, resolving, and trending claim issues, and assisting in training and education.
• Maintains assigned Health Ministry dashboards; unit department and various WQ’s to ensure account movement through the revenue cycle in a timely manner.
• Organize work required to accomplish SSM Revenue Integrity Audit goals and priorities.
• Ensure that RI Audit team objectives align with strategic vision of SSM Health.
• Develop training plan for department as appropriate around specific work (e.g., epic training, payor audits, defense audits, procedure audits for RI Audit team.
• Lead the Denial and Write-Off Initiatives based off RI audits in an effort to mitigate denials and write-off opportunities.
• Perform problem resolution with Revenue Integrity Analytic Specialist team, Clinical Partners, and Consultants – within and outside of SSM Health.
• Manage project tracker, audit tracker, monthly KPI’s for leadership that feed various status reports.
• Communicates issues, resolution steps, risks, and barriers, to RI Audit Director, leadership, project teams, and project sponsor(s), and stakeholders, as appropriate for escalation/resolution.
• Provide regular status of current efforts, achieved milestones, and current risks and issues to Director.
• Work with Leadership, Revenue Integrity Specialist, PBS, and IHT Leaders to define, coordinate, and implement changes to Epic system and/or SSM workflows to mitigate denials/write-offs.
• Facilitate RI Audit team meetings and huddles with RI Audit Analytic Specialist.
• Prepare and present achievements and barriers to sponsors and/or senior leadership to drive decisions and clear barriers to project outcomes.
• Navigate interest of different stakeholder groups to deliver improved revenue integrity outcomes.