Western Missouri Medical Center

Non-profit acute care hospital and clinics

Revenue Integrity Specialist

AccountingPosted on Nov 12

Full-timeWarrensburg, MO, USANo salary listed

About the Job

Requirements

A bachelor's degree in a business-related field or equivalent experience is required.
A strong understanding of acute payer contracts is required.
At least 3 years of healthcare billing, revenue cycle, or claims experience is required.
Experience working in an electronic health record system is required; MEDITECH experience is preferred.
Ambulatory and acute billing experience is required.
Current residency in Missouri or Kansas is required.
The role requires sitting and standing intermittently for 8 to 10 hours per day.
The role requires use of standard office equipment, including a telephone and computer keyboard.
The role requires maintaining near-100% accuracy while working under pressure and meeting inflexible deadlines.
The role requires manual and bimanual dexterity, near vision, speech, and hearing.
The role frequently requires standing, walking, sitting, eye-hand coordination, and color definition.
The role occasionally requires reaching above the shoulder and regularly requires lifting or carrying up to 40 pounds.
The role occasionally requires walking on uneven surfaces.

Responsibilities

Review payment variances using MEDITECH Contract Management.
Compare expected reimbursement with actual payments.
Identify payer underpayments and overpayments.
Research reimbursement discrepancies.
Coordinate payment variance appeals.
Review payer contractual compliance.
Monitor reimbursement trends.
Collaborate with the Director regarding contract interpretation.
Assist with payer implementations and fee schedule updates.
Maintain expected reimbursement models.
Develop reports identifying payment integrity opportunities.
Collaborate with Payment Posting, Insurance Follow-Up, Denial Management, and Finance.
Recommend operational and contractual improvements to maximize reimbursement.

Desired Qualifications

Experience with MEDITECH is preferred.

Description

PURPOSE STATEMENT

The Revenue Integrity Specialist is responsible for ensuring reimbursement accuracy by monitoring payer payments, identifying reimbursement variances, validating expected reimbursement using contract management tools, researching underpayments and overpayments, and supporting contract compliance initiatives. This position plays a key role in protecting organizational revenue through payment integrity, contract analysis, and continuous process improvement.

ESSENTIAL FUNCTIONS

Review payment variances using Meditech Contract Management.
Compare expected reimbursement to actual payments.
Identify payer underpayments and overpayments.
Research reimbursement discrepancies.
Coordinate payment variance appeals.
Review payer contractual compliance.
Monitor reimbursement trends.
Collaborate with the Director regarding contract interpretation.
Assist with payer implementations and fee schedule updates.
Maintain expected reimbursement models.
Develop reports identifying payment integrity opportunities.
Collaborate with Payment Posting, Insurance Follow-Up, Denial Management, and Finance.
Recommend operational and contractual improvements to maximize reimbursement.

Requirements

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

High school diploma or equivalent.
Bachelor’s Degree in business related field or equivalent experience required.
Strong understanding of Acute Payer Contracts is required.
3+ years of healthcare billing, revenue cycle, or claims experience.
Experience working in an EHR system (MEDITECH preferred).
Ambulatory and Acute Billing experience.
Current residency in the state of Missouri or Kansas is required.

Performance Metrics

Underpayment Recovery Dollars.
Payment Variance Resolution Time.
Expected Reimbursement Accuracy.
Contract Compliance.
Payment Integrity Opportunities Identified.
Financial Impact of Revenue Recovery.

PHYSICAL/MENTAL REQUIREMENTS

Must be able to sit and stand, intermittent 8 to 10 hours a day.
Must be able to use standard office equipment, including the telephone and computer keyboard.
Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
Occasionally walks on uneven surfaces.

About the Company

Western Missouri Medical Center

Non-profit acute care hospital and clinics

Western Missouri Medical Center is a non-profit acute-care hospital serving Johnson County and surrounding communities. It offers emergency services, primary and family medicine, obstetrics, orthopedics, general and specialty surgery, diagnostic imaging, a cancer center, a birth center, and express care, supported by a Level III Stroke Center and Level III Trauma Center. The hospital funds its work through patient revenue and support from the WMMC Foundation, reinvesting in facilities and technology to expand local care. Its goal is to provide high-quality, locally accessible medical services so people can get treatment close to home and avoid unnecessary travel.

Company size: 201-500
Company stage: Not listed
Total funding: Not listed
Headquarters: Warrensburg, MO
Founded: 1963

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