Revenue Integrity Operations Analyst

Pay range: $28.94 - $43.40 per hour, based on experience.

This position comes with a comprehensive benefits package that includes medical, dental, vision, a 403(b) retirement plan, and a generous Earned Time Off (ETO) program.

In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved state listed (or do not plan to relocate to an approved listed state) we request you do not apply for this particular position.

States approved by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin.

ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION

TITLE:                                          Revenue Integrity Operations Analyst     

REPORTS TO POSITION:          Manager Chargemaster and Charge Integrity

DEPARTMENT:                           Revenue Integrity

DATE LAST REVIEWED:            07/02/2024

OUR VISION:               Creating America’s healthiest community, together

OUR MISSION:             In the spirit of love and compassion, better health, better care, better value

OUR VALUES:               Accountability, Caring and Teamwork

DEPARTMENT SUMMARY: The Revenue Integrity (RI) department focuses on charge capture optimization and documentation improvement through collaboration and education. The Revenue Integrity department provides many services to our multi-hospital and medical group organization focusing on the patient financial experience along the entire continuum of care. Our goal is to deliver delightful, transparent, and seamless experience to our patients and customers that captures and collects the revenue earned by St. Charles Health System (SCHS) in a quality, efficient and timely manner.

POSITION OVERVIEW: The Revenue Integrity Operations Analyst at St. Charles Health System (SCHS) is responsible for working and resolving edits assigned to Revenue Integrity. This specialist will support clinical departments responsible for working decentralized edits. This role also maintains, reviews and updates the master list of 3rd Party Edits, including identifying incorrect edits and determining if new edits are appropriate. Additionally, this role will serve as a resource and back-up to the chargemaster team and therefore will help with identifying CPT codes, revenue codes or payer specifics for charging and reimbursement of services provided. This role is responsible for performing Epic build tasks that resolve issues, mitigate revenue leakage, improve workflow efficiencies, and support the overall department goals. This position does not directly manage any other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES:

Reviews and corrects issues with hospital-based charges triggering 3rd Party Edits or Revenue Guardian Checks.

Maintains and updates master list of edits and revenue guardian checks for hospital-based services for SCHS.

Audits, trains, and educates internal RI caregivers and clinical department caregivers assigned to working edits, revenue guardian checks and RI owned work queues.

Serves as a back-up to the Chargemaster team as departmental/organizational needs dictate. This includes attending annual chargemaster reviews.

Researches and resolves CPT code, revenue code, and other issues.

Identifies services that are reimbursable but are not being coded or charged; reviews, assigns, and validates charge information such as correct revenue codes and CPT/HCPC codes.

Supports clinical areas and departments in charge capture, coding accuracy, resolution of regulatory and payer specific edits, and revenue management to ensure organization-wide uniformity of charges and coding for similar services and procedures.

Identifies/investigates issues with medical necessity, coding, and billing that reduce reimbursement; recommends action steps and works collaboratively with the departments and clinics to improve processes when operational weaknesses and/or compliance issues are found.

Leads meetings with RI and other St Charles departments.

Completes and provides reports to leadership as requested.

Completes EHR build, system maintenance, troubleshooting and resolution tasks within certification scope. Investigates standardization and process improvement opportunities while making build decisions.

Designs and executes application testing as required.

Troubleshoots, identifies root cause, and documents problems for assigned Epic applications. Works directly with Epic Technical Support to determine appropriate resolution to operational requirements and issues.

Supports the vision, mission, and values of the organization in all respects.

Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.

Provides and maintains a safe environment for caregivers, patients, and guests.

Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.

Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate. 

May perform additional duties of similar complexity within the organization, as required or assigned.

EDUCATION:                  

Required:    High school diploma or GED.

Preferred:    Associates or Bachelors degree in Health Information Technology or related field.

LICENSURE/CERTIFICATION/REGISTRATION:

Required:    RHIT, RHIA, CCS, CPC within 1 year of date of hire, current Epic Revenue Cycle Builder, or ability to obtain within 6mo of date of hire.

EXPERIENCE:

Required:   1-3 years coding/auditing/collections experience including coding/billing edits resolution in a hospital and or physician practice setting.

Preferred:   3+ years in coding/auditing. 

PERSONAL PROTECTIVE EQUIPMENT

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

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