Contracting and Revenue Integrity Specialist

Job Description

Job Description

General Information:

Job title: Contracting and Revenue Integrity Specialist

Schedule: 80 hours per pay period; Monday - Friday - 8:00am to 4:30pm

Weekend Requirement: No weekends

Holiday Requirement: Paid holidays

Position Summary:

The Contracting and Revenue Integrity Specialist supports the Chief Financial Officer in managing payer contracting activities, reimbursement analysis, and revenue optimization initiatives for the hospital and affiliated clinics, nursing homes, and retail pharmacies. The position is responsible for maintaining the organization's Charge Description Master (CDM), monitoring reimbursement performance, supporting contract negotiations, and ensuring compliance with applicable billing and regulatory requirements.

This role serves as a key liaison between Administration, Finance, Patient Financial Services, Clinic Operations, Compliance, and Clinical Departments to promote accurate charging, maximize reimbursement, and maintain the financial integrity of Mile Bluff Medical Center services.

Position Responsibilities:

• Assist the CFO by coordinating negotiation, renewal, and implementation of managed care contracts with commercial insurers, Medicare Advantage plans, Medicaid Managed Care Organizations, and other payers.
• Review care agreements and analyze reimbursement methodologies, fee schedules, and payment policies.
• Perform financial analyses to assess the impact of proposed contract terms and reimbursement changes.
• Maintain payer contract files, renewal schedules, and reimbursement documentation.
• Develop reimbursement and contract performance reports. Prepare reports and recommendations for CFO regarding contract performance and reimbursement trends.
• Maintain and update the medical center Charge Description Master (CDM).
• Coordinate annual and ongoing reviews of charge structures, HCPCS, CPT, revenue codes, and pricing. Ensure compliance with Medicare, Medicaid, commercial payer, and regulatory billing requirements.
• Collaborate with department leaders to establish charges for new services, procedures, equipment, and supplies. Monitor coding and billing changes impacting charge capture and reimbursement.
• Identify opportunities to improve charge capture and reimbursement accuracy.
• Monitor compliance with billing regulations and payer requirements.
• Analyze reimbursement impacts related to new services and programs.
• Support regulatory audits and documentation requests.
• Coordinate enrollment, revalidation, and maintenance activities for hospital and clinic providers with Medicare, Medicaid, commercial payers, and managed care organizations.
• Add newly hired providers to managed care contracts and payer networks in a timely manner to prevent reimbursement delays.
• Serve as the organization's primary administrator for Medicare Provider Enrollment, Chain, and Ownership System (PECOS) activities. Maintain hospital, clinic, and provider enrollment records within PECOS.
• Maintain organizational and provider enrollment records within Wisconsin Forward Health.
• Coordinate Medicare, Medicaid, and Commercial payer revalidations, ownership updates, provider additions and deletions, practice location changes, and other enrollment actions.
• Perform other duties as requested.

Position Requirements:

• Associate degree in Business Administration, Accounting, Healthcare Administration preferred.
• Minimum three years of experience in healthcare finance, reimbursement, managed care contracting, chargemaster management, revenue integrity, revenue cycle, or related healthcare operations required.
• Experience with Rural Health Clinics or rural healthcare organizations preferred.

Knowledge, Skills, & Abilities

• Knowledge of hospital and clinic reimbursement methodologies.
• Understanding of Medicare, Medicaid, commercial insurance, and managed care contracts.
• Knowledge of chargemaster maintenance, charge capture, CPT/HCPCS coding, and revenue codes.
• Strong analytical and financial modeling skills.
• Advanced proficiency in Microsoft Excel and healthcare financial reporting tools.
• Ability to interpret contractual language and reimbursement methodologies.
• Strong organizational, communication, and project management skills.
• Ability to manage multiple priorities and work independently.

Why Mile Bluff Medical Center?

Mile Bluff Medical Center is a place where people come first. Our team is comprised of caring, patient-centered professionals serving pediatric through geriatric populations in our rural community. Our not-for-profit organization prides itself on providing state-of-the-art healthcare services, a positive work environment, and a team where employees feel valued and supported. Mile Bluff is an independent organization that offers competitive wages, great benefits and the opportunity for growth. Mile Bluff makes decisions for its employees and patients locally without relying on a large health system in another community.