Location: Springfield,MO, USA
Job Description:
Job Title: Compliance Claim Integrity Specialist
Location: Springfield, Missouri
Department: Compliance and Integrity
Employment Type: Full-Time
Job Summary:
Join our dedicated Compliance Office team as a Compliance Claim Integrity Specialist, where you will play a crucial role in ensuring the integrity of our billing and reimbursement processes. This position offers the opportunity to make a significant impact by identifying potential overpayments and contributing to the improvement of our compliance practices. We are looking for a detail-oriented individual with strong analytical skills, a commitment to ethical practices, and a passion for supporting our mission of providing quality healthcare. Your expertise will help us maintain the highest standards of compliance while fostering a collaborative and supportive work environment.
In this role, you will conduct thorough investigations into billing, coding, and documentation concerns, analyze payor refund requests, and collaborate with various departments to ensure timely repayment of identified overpayments. Your findings will be instrumental in shaping our compliance strategies and enhancing our operational efficiency.
The Compliance Claim Integrity Specialist position offers
* Employee Assistance Program - 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
* Career Advancement & Wage Growth - Grow in your career with great opportunities for upward mobility and added income
* Comprehensive Training - Learn and develop skills with our robust on-the-job training
* Workplace Culture - An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting healthy, joyful workforce engagement
Key Responsibilities:
* Conduct investigations of billing, coding, and documentation concerns identified through the Compliance Disclosure Program.
* Analyze and investigate payor refund requests and provide recommendations on responses, such as submitting appeals or issuing refunds.
* Document the investigation process with a high level of detail and compose written reports that include determinations and corrective actions.
* Identify and report abnormal billing patterns and other indicators of suspected fraud and abuse to the Lead Compliance Audit Coordinator.
* Collaborate with members of the Revenue Cycle Department to ensure timely repayment of any identified overpayments.
* Present findings and recommendations in a professional and knowledgeable manner.
* Demonstrate problem-solving strategies and recommend corrective actions for deficiencies, including assisting with developing recommendations for changes in policies and procedures relevant to compliant billing processes.
* Support the Compliance Office with other duties as assigned.
Education, Experience, and/or Credential Qualifications:
* Associate degree in Health Information Management, preferred
* At least one of the following credentials: RHIA, RHIT, CCS, CPC, COC, strongly preferred
* 1 to 3 years of medical billing experience with preferred education
* 5 years of industry experience, including 1-3 years of medical billing experience without preferred education
* Prior behavioral health coding or billing experience, preferred
Additional Qualifications:
* Successful completion of background check including criminal record, driving record, abuse/neglect, and fingerprint check
* Current driver's license, acceptable driving record, and current auto insurance
Physical Requirements:
* Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, or pull, or otherwise move objects, including the human body.
* Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift.
* Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
Brightli is on a Mission:
We are committed to changing and saving lives through our work. If you are passionate about compliance and making a difference in the healthcare industry, we encourage you to apply and join our mission-driven team!
Keywords: Compliance, Billing, Coding, Healthcare, Investigation, Reimbursement, Fraud Prevention, Regulatory Compliance, Revenue Cycle, Medical Billing
We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.
Brightli is a Smoke and Tobacco Free Workplace.