Revenue Integrity Analyst

Overview:

The Revenue Integrity Analyst is responsible for performing and implementing charge capture and process improvement initiatives to optimize performance and improve revenue management. This position is also responsible for working with service lines to conduct root cause analysis, developing corrective action plans, educating internal customers, and monitoring results. This position will collaborate with the Revenue Integrity team to operationalize Northern Arizona Healthcare’s Revenue Integrity strategy and plan for improving revenue results across all departments, financial processes, functions, and interdependencies from patient care to final payments.

* This is a Remote position - "NAH reserves the right to make hiring decisions based in part on applicants' state of residence if outside the state of Arizona".

Reporting
• Prepare and distribute monthly adjustment reports to Clinical areas for continued education

• Prepare and distribute monthly revenue trend reports to specific Clinical areas for follow-up

• Monitor and balance monthly charge/revenue reporting working with service lines and finance

Revenue Integrity Analysis
• Analyze complex financial data

• Identify trends in revenue cycle operations

• Summarize data and present reports to leadership

• Serve as liaison with departments to thoroughly define reporting and information requirements

• Evaluate revenue cycle workflows to identify areas for improvement

• Oversee charge integrity, reconciliation, and charge linkages from ancillary charging systems

• Train patient financial services units on revenue cycle systems, processes, and procedures

• Maintain compliance with government regulations, reimbursement issues, etc.

• Analyze hospital billing claims within the EHR and claim scrubber system

• Resolve claim errors, edits, and other holds

• Works with clinical and ancillary operational departments on the correct coding, billing, and charging principles protocol

Analytics and Root Cause Analysis
• Perform quantitative and financial analysis along with audits designed to identify opportunities for improvement across the full spectrum of the Revenue Cycle

• Conduct analytical reviews to determine the net revenue effect of proposed charge master and fee schedule changes

• Perform internal billing audits to ensure correct coding/billing regulatory compliance and charge capture accuracy

• The incumbent must develop close working relationships with management and staff in Revenue Integrity, Finance, Information Technology, and Revenue and Clinical Operations, allowing them to perform deep-dive analyses and reviews that assist with identifying trends, solutions, and potential corrective action steps

• Will work both independently and have a high level of self-directed work efforts as well as be an integral part of the Revenue Integrity Team

• Participate in ongoing coordination and resolution of revenue issues as they arise

• Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations

• Assist with Cerner performance reporting, including assisting with Revenue & Usage, Enterprise Charge Reconciliation, and Volume Reports

• Assist in researching coding issues, provide guidance, and recommend solutions to account representatives.

• Analyze billing errors and denial data to identify the root cause of issues

• Work with the Revenue Integrity Team, Clinical Operations, and Patient Financial Services staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials, and ensure accurate reimbursement

• Participate in ongoing coordination and resolution of revenue issues as they arise

• Provide the Director and Manager input for the annual Revenue Integrity planning process

• Assist with additional projects as needed

Education
• Associate’s Degree preferred.
• Required Education: High school diploma or G.E.D.

Certification & Licensures
At least one of the following preferred: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Revenue Cycle Representative (CRCR) or certification from AHIMA, AAPC, AAHAM, HFMA, and NAHRI

Experience
• Five or more years of experience with hospital billing systems and third-party billing requirements, preferred
• 3 to 5 years Cerner Suite EHR or Sorian
• Ability to work collaboratively across disciplines and business lines
• Exceptional oral/written communication skills and highly customer-focused
• Excellent interpersonal and presentation skills
• Able to communicate with many various customers
• Ability to prioritize, plan and execute
• Excellent critical thinking and analytical skillset experience
• Experience in revenue integrity operations, clinical charge capture, charge master, or revenue cycle operations
• Proficiency with Microsoft Excel
• Knowledge of Tableau Reporting dashboards