Revenue Integrity Systems Administrator at Mental Health Center of Denver in Denver, Colorado

Job Description:

WellPower provides you with the support you need to help you develop a career in helping others succeed. We innovate, adapt, and leverage the diverse perspectives of the people on our team and the people we serve in everything we do.

WellPower values and is strengthened by diversity. We are committed to ending bias and discrimination in our community and ensuring equity within all aspects of our organization. We are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment, transfer, or promotion opportunities without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status

Within WellPower's Finance Department, but also collaborates with the Information Systems, Quality Systems, Training, and HISM to support accurate claim submission based on current payer rules and contracts. Leverages programs like MS SQL Server, DB Visualizer, and SAP Crystal Reports. This position collaborates directly with AR Manager to identify trends for both denied and unbilled claims, fix issues within EHR preventing clean claims generation, and ensure all EHR Program Maintenance updates are implemented in a timely manner.


Learn more about WellPower:




Compensation and Benefits:

• $66,896 - $85,053 per year

WellPower is committed to fair and equitable hiring with salaries based on relevant factors, such as work experience, education, and certification/licensure (rather than wage history). Toward the principle of equal pay for equal work, we post and hire within defined hiring salary ranges. We ask all applicants to carefully review the hiring salary range for each posted job opportunity, as we will not hire outside the predetermined range.

All full-time, benefits eligible employees will be eligible for WellPower's benefits plan. For a full description of benefit offerings, please visit: https://WellPower.org/workplace-of-choice/.


ESSENTIAL JOB FUNCTIONS:

• Apply Medicare, Medicaid, and Third-Party Payer billing rule knowledge to ensure EHR billing is updated as payer rules update.
• Create reporting systems to analyze 835 ERAs from payers and alerts management of changes in allowed amounts, adjustment reason codes, amounts paid, etc. from historical trends.

• Ensure Program Maintenance side of EHR is configured to send unbilled claims, receive 837 files, and post all payments/adjustments efficiently.

Billing Processes:

• Edit Service Fee Cross Reference when there are new rates, service codes, service programs, locations, staff types, errors identified or changes to the way payers require claims data.
• Edit Guarantor Definition when there are new rates, service codes, service programs, locations, staff types, modifiers, errors identified or changes to the way payers want claims data for a payer that is configured in this form.
• Maintain Program Maintenance Facility Defaults, quick billing rule definitions, and 837 billing default templates.
• Review and test monthly and quarterly Program Maintenance updates into Avatar.
• Handle installation, testing, documentation and training for any new Program Maintenance -related update/process being introduced.
• Notify/train AR team when any monthly update results in changes to the user interface or functionality within EHR.

State Reporting

• Work with AR Manager to ensure that all protocol changes that affect eligibility, claim submission and/or special studies code assignment are implemented.
• Oversight of monthly BHA claim submissions - ensuring all corrections and original claims are submitted accurately and in a timely manner.
• Support the identification of BHA service correction needs.

Revenue Cycle Analysis:

• Assist AR Manager to investigate and design standards to improve revenue cycle statistics, reporting capabilities, and overall performance.
• Identify and rectify claim system errors to eliminate claim denial and unbilled claim trends which impact cash flow.
• Perform analyses of current processes and suggest workflow changes to reduce redundant processes.
• Support the creation of SSMS (SQL) reports to streamline AR Team workflows as needed.

JOB REQUIREMENTS:



EDUCATION: Associate degree in business, finance, or computer science, or equivalent experience


EXPERIENCE: Accounting and/or non-profit financial experience. Project Management experience desirable. Experience developing custom reports using T-SQL and SSMS or Crystal Reports.


SKILLS AND COMPETENCIES:

• Strong customer service skills with a desire to put People We Serve's needs at the forefront.
• Provides outstanding service through empathy, issue resolution and follow through.
• Ability to identify root cause of issue and design logical approach for resolution.
• Ability to organize and prioritize work to meet productivity expectations and/or deadlines.
• Ability to solicit and act on constructive feedback, challenge oneself, and demonstrate resilience in the face of opposition.
• Collaborative communication skills (verbal and written) - ability to effectively interact with internal and external customers while maintaining composure during stressful situations.
• Takes ownership for the quality and timeliness of work and can achieve result with little oversight.
• Adept with various software including but not limited to: Avatar/EHR, Microsoft products focused on Outlook and Excel.
• Must be able to work in a diverse work environment with people from all walks of life.
• Internet, Microsoft Office computer experience with word processing, spreadsheets, and similar programs.

• T-SQL, SSMS, Crystal Reports

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