What are the responsibilities and job description for the Sr. Revenue Integrity Analyst position at St. Joseph's/Candler?
Position Summary
Revenue cycle is bound by a complex set of rules and regulations: the Sr. Revenue Integrity (RI) Analyst must have extensive knowledge of coding guidelines, CPT /HCPC codes and modifier rules, APC structure and payment specifics, OPPS and hospital billing rules; and physician coding and billing rules. Responsible for monitoring revenue workflows and ensure compliant capture of revenue. Collaborate with hospital and ambulatory departments including physician practices, hospital clinical departments, Health Information Services and Revenue Cycle teams to solve cross departmental issues. Research complex billing and coding scenarios. Must maintain required credentials, mentor and support new Revenue Integrity co-worker development. Work closely with the Revenue Integrity Leadership on process improvement and opportunities for improved charge capture. Must be able to apply policies and procedures to solve every day problems and deal with a variety of situations and personalities.
Education
Bachelors in Health Science - Preferred
Medical terminology - Required
Courses in computer technology, medical billing, process improvement and medical coding - Preferred
Experience
3-5 Years hospital/physcian practice revenue cycle, revenue integrity, health information services or combination of experience - Required
Must have knowledge of Revenue Cycle processes, specifically the workflow from clinical charge entry, coding, billing, claims requirements and processing; reimbursement; and denials. Medical terminology and prior experience with electronic medical records systems (EMRs) and healthcare billing systems - Required
Written and verbal communication skills, proven ability to reach across departments to problem solve - Required
Proficient in use of spreadsheets including Excel, and skilled in gathering, analyzing and evaluating data to uncover trends and patterns of billing, coding, charging and reimbursement opportunities – Required
AHIMA RHIT; AAPC Coding certification such as Certified Professional or Outpatient Coder (CPC or COC); or AAHAM Certified Revenue Integrity Professional (CRIP) or Certified Revenue Cycle Professional (CRCP) - Required or obtained within nine (9) months from date of hire.
Core Job Functions
Serves as primary Revenue Integrity contact to monitor and provide guidance to clinical departments on charge capture, charge reconciliation, and monitoring of late charges. Ensures that charge rejections are monitored and change corrections are made in an accurate and timely manner. Works with clinical departments on process improvements to reduce charge lag time and decrease late charges.
Serves as primary analytical resource for the Revenue Integrity Department by analyzing data from established daily reports. Creates new reports using Meditech, Visiquate and Trisus Claims Informatics (TCM) as requested by Clinical and Revenue Cycle Leadership to identify trends or improvement opportunities. Alerts the Revenue Integrity Leadership about identified charging trends or patterns, opportunities for process improvements, etc. Collaborates with Revenue Cycle Analytics coworkers/team to develop reports, key performance metric (KPI) dashboards, and other methods to share information on revenue capture.
Works with CDM team to monitor and audit new services/charges to ensure appropriate usage, billing, and reimbursement. Provides feedback to departments on findings. May assist with Charge Description Master (CDM) projects, if needed.
Provides updates to clinical and non-clinical departments on charge capture, coding & billing regulatory and contracted managed care payer policy changes. Remains up to date with the various Federal and managed care correct claim submission regulation/policies.
Assists Revenue Integrity Leadership in quarterly review of the Charge Description Master (CDM) and annual pricing review.
Provides coverage for core job functions of the CDM Analyst, RI Analyst and Charge Auditor, when needed. May include resolving claim edits, Meditech account checks, completing charge entry and audits for ED or OBED, Meditech tasks, etc.
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