Revenue Integrity Analyst II

This is a fully remote opportunity.

Hours: Monday through Friday from 8:00 AM to 4:30 PM

Job Profile Summary
This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing.  In addition, this role focuses on performing the following Revenue Integrity duties: Responsible for compliantly maximizing financial reimbursement for clinical services provided to patients. Identifies financial reimbursement degradation, maintaining fee schedules, etc.  An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, nonclinical) operating in a “hands on” environment.  The majority of time is spent in the delivery of support services or activities, typically under supervision.  An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education.  Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Job Overview

This position is responsible for charge creation and pricing, understanding charge capture methodologies available in Epic, charge compliance with intent of service and correct coding, charge reconciliation workflows and training, periodic regulatory and coding changes and updates, charge capture and billing error review and root cause analysis, collaboration with front and back end revenue cycle operations to understand denials and variances to ensure charge build and charge capture processes, and methodologies are aligned with payer expectations.

Minimum Qualifications:

1. Bachelor’s degree in Business, Healthcare, or closely related field OR Three (3) years of healthcare experience in lieu of Bachelor's Degree.

2. Five (5) years of experience in Revenue Cycle including extensive knowledge of revenue cycle processes, hospital/medical billing (CDM, UB, RAs and 1500), Code data sets (CPT, HCPCS, and ICD), NCCI edits, and Medicare LCD/NCDs, and reimbursement standards (DRG, OPPS, HCC, and managed care).

Preferred Qualifications:

1. Applicable Certifications: CPC, CCS, CHRI, CRCR, Epic Revenue Integrity/Chargemaster.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned.

1. Develops relationships with key stakeholders to develop trust that facilitates influence.
2. Learns and understands services provided to patients.

3. Educates key stakeholders on charge compliance, correct coding, and intent of service of charges.
4. Regularly reviews established charge codes to ensure accuracy and compliance.

5. Creates new charge codes with accurate and payer specific default and alternate coding combinations to ensure maximum reimbursement.

6. Develops charge capture reconciliation processes in collaboration with key stakeholders.

7. Maintains a supportive role with charge reconciliation for key stakeholders. 8. Reviews charge capture workflows and works with the appropriate teams to adjust methods and processes to reduce charge errors improve clean claims.

9. Monitors revenue routing to ensure revenue is aligned with expenses.

10. Analyzes charge errors to determine root cause.

11. Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for service line leaders.

12. Performs ongoing reviews to gauge the efficacy of performance improvement initiatives for charge capture, charge reconciliation, and charge error reductions.

13. Coordinates training with HIM and other experts with key stakeholders to improve charge capture and to reduce errors and denials.

14. Collaborates with key constituents in different functional areas to create charge and billing reports that meet the organization’s requirements and trains individual departments on how to properly generate such reports.

15. Continuously seeks and obtains training to stay aware of industry behaviors and best practices.

Physical Requirements: 

1. Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.

2. Frequently required to speak, hear, communicate and exchange information. 3. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.

4. Occasionally lift and/or move up to 25 pounds.

Skills & Abilities:

1. Excellent communication skills and the ability to effectively communicate with all areas of Patient Financial Services as well as Revenue Cycle.

2. Excellent interpersonal skills with the ability to react in a professional manner. Excellent interpersonal and communication skills and a basic understanding of team management concepts.

3. Ability to work independently and as part of a team in a fast-paced environment to satisfy the needs to support all areas of Patient Financial Services.

4. Maintains current knowledge of rules and regulations governing third party payers and working knowledge of various billing tasks.

5. Ability to use computerized billing and A/R systems and various PC based programs (Excel, MS Word)

6. Organizational and time management skills in order to complete tasks within a specified time.

7. Ability to develop and maintain professional, service-oriented working relationships with leadership, patients, and co-workers.

8. Ability to work independently or in a team environment.

9. Attention to detail to ensure a must to ensure correspondence is distributed to appropriate areas of Revenue Cycle.

10. Ability to learn PC based computer systems, word processing, database and spreadsheet software programs. Proficient in using computers and navigating through third party application systems and web portals efficiently and effectively.