Revenue Integrity Analyst

About the role

This position performs reporting and analysis of the revenue cycle for monitoring and problem resolution; assists staff with internal and external system issues, audits and questions relative to accounts receivable; acts as a primary liaison with other parties to resolve system issues and ensure compliance with all regulations; participates in department/system initiatives involving testing and other activities to ensure overall goals are met. Collaborates with facility/department leadership on a continuum basis.

Responsibilities

• Performs financial, statistical and operational projects; presents detailed analysis of A/R performance and other financial reports and related outcomes/trends.
• Researches and validates clinical data used to support medical necessity of billed services; conducts quality assurance reviews of various billing components, technical requirements, supporting processes, systems and required documentation.
• Reviews outcomes with a wide array of stakeholders (e.g., Practice/clinical Directors, Practice/clinical Managers, senior leadership, Coding Manager, hospital case management, managed care contracting and RCC management) and influences adjustments to current facilities and practices.
• Assists with maintaining the integrity of the CDM (charge description master) and the software program.
• Performs ad hoc consultative research and coordination on current issues of Revenue Cycle regulatory risk including medical necessity denials; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal and external.
• Serves as the Revenue Cycle regulatory liaison between the Practice and the RCC for efficient management of accounts receivable, point of service Revenue Cycle activity and all other areas within the Revenue Cycle area; serves as an internal audit consultant to clinical providers.
• Identifies barriers and implements corrective action measures in partnership with leaders to ensure positive outcomes.
• Provides ongoing guidance, training and support to practices and departmental Revenue Cycle staff.
• Monitors and audits Revenue Cycle issues; monitors facility departments, Practices and RCC staff performance relative to current Revenue Cycle policies and procedures, including medical necessity issues of billed services through sample audits.
• Researches regulatory concepts for gaps and opportunities to improve Revenue Cycle compliance; identifies under- and over-charge items for immediate resolution by the provider/practice; identifies areas for risk as well as improvement—conducts assessments both desk level and on site.
• Provides ongoing education to departments, practices and RCC staff concerning practice management system, coding and regulatory complexities (e.g., billing and A/R management workflows, policies and requirements).
• Develops and implements action and educational plans to target resolution of Revenue Cycle issues; identifies training needs as well as appropriate hand-off for designated topics.
• Assists with training and implementation of PM system for newly acquired Hospitals, ASC’s and practices relative to front-end Revenue Cycle edits or other systematic issues and supportive medical record documentation.
• Collaborates with Compliance, Budget Office, Patient Accounts, Health Information Services, Internal Audit and other Revenue and Finance departments on revenue management initiatives.
• Develops and maintains a Quality Audit program and associated reporting; assists in performance of quality audits related to RI liaison and charge review coordinators identified areas of opportunity.

Requirements

• Minimum High School/GED
• 1–3 years in hospital or physician revenue cycle, billing, coding or billing

Qualifications

• Preferred Bachelor’s Degree in Business, Healthcare or related field
• 1 year in Project Management
• 1 year in an Epic-billing environment

Pay

Base pay range: $28.19 – $44.13 per hour. Base pay is determined by qualifications, experience, internal peer equity, market and business considerations; the displayed range does not reflect any geographic differential.