Revenue Integrity Systems Administrator

 

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

Position Summary:

The Revenue Integrity Systems Administrator plays a critical role in ensuring the integrity and optimization of billing systems within WellPower’s Finance Department. This position collaborates cross-functionally with Information Systems, Quality Systems, Training, and Health Information System Management (HISM) to support accurate claim submissions aligned with evolving payer rules and contracts. Leveraging tools such as Microsoft SQL Server, DB Visualizer, and SAP Crystal Reports, this role partners closely with the Accounts Receivable Manager to analyze trends, resolve claim issues, and implement timely updates to the EHR Program Maintenance.

Learn more about WellPower:

 

Compensation and Benefits:

• $70,000 - $100,000 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:

• Claims Configuration & Payer Rule Compliance
• Apply knowledge of Medicare, Medicaid, and Third-Party Payer billing regulations to ensure accurate EHR billing setup in accordance with current rules.
• Maintain and configure EHR Program Maintenance settings to ensure timely and accurate submission of unbilled claims, 837 transactions, and payment posting.
• Edit service fee cross-references and guarantor definitions to reflect updates in rates, codes, service programs, locations, and payer-specific requirements.
• Maintain facility defaults, billing rule definitions, and 837 templates to align with organizational and payer standards.
• Review, test, and implement monthly and quarterly Program Maintenance updates to Avatar EHR, ensuring proper documentation, installation, and staff training.

 

 Revenue Cycle Analysis & Optimization:

• Create and manage reports analyzing 835 ERAs to identify changes in payment trends, adjustment codes, and reimbursement rates.
• Investigate and resolve system errors contributing to denials and unbilled claims to improve overall cash flow.
• Collaborate with the AR Manager to enhance revenue cycle performance through workflow improvements and standardized reporting metrics.
• Develop custom SQL-based reports (via SSMS or Crystal Reports) to support AR team workflows and streamline operational processes.

State & Regulatory Reporting:

• Oversee monthly BHA claim submissions, ensuring timely and accurate transmission of both original and corrected claims.
• Implement protocol changes impacting eligibility, claims processing, and special studies coding in collaboration with the AR Manager.
• Support the identification and correction of errors impacting BHA service submissions.

Communication and Collaboration:

• Train AR staff on EHR system changes affecting the billing interface or functionality.
• Act as a subject matter expert in cross-functional efforts involving system updates and process redesigns.
• Maintain a trauma informed environment of wellbeing.
• Perform other duties as assigned.

REQUIRED QUALIFICATIONS:

• Associate degree in Business, Finance, Computer Science, or equivalent experience required.
• Experience in accounting and/or non-profit financial operations required.
• Project management experience preferred.
• Proficiency in developing custom reports using T-SQL and SQL Server Management Studio (SSMS) or Crystal Reports required.

 

Typical Physical and Mental Demands:

Requires sitting, standing, bending and reaching. May require lifting up to 50 pounds. Requires manual dexterity sufficient to operate standard office machines such as computers, fax machines, the telephoneand other office and/or clinical equipment.

Working Conditions:

May require occasional evening or weekend hours upon request.