Revenue Integrity Specialist

Under the direction of the Sr. Manager, Revenue Integrity, the Revenue Integrity Specialist is responsible for complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules. They will address requests for Care Center payment performance audits to assist in maximizing cash flow and track the outcomes of both standard payer audits and requested Care Center audits. Primary duties include auditing systems to ensure accurate provider information, ensuring accurate reimbursement by auditing claims, conducting Care Center audits, assisting in initiatives to drive efficiency, making independent decisions regarding audit results, and ensuring adherence to escalation processes. The specialist will also identify denial management trends and assist with Trizetto/Cognizant setup and fee schedule setup.