Revenue Integrity Analyst
Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service. CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities. As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school.
Responsibilities
- Determine the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding by reviewing and analyzing medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices.
- Verify charging and billing data for accuracy and completeness and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, ePremis, or in the payers system.
- Serve as a liaison between facility administration, patient accounts, and ancillary department directors regarding charging issues, clinical documentation issues, and revenue opportunities.
- Provide review results and develop and coordinate educational in-services for facility staff related to charging/billing issues.
- Collaborate with the compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.
Requirements
- Five years experience in a role related to revenue capture/charging, auditing, coding, or compliance is required.
- Clinical experience is preferred.
- Experience with PCs, word processing, spreadsheet, graphics, and database software applications is required.
- Strong quantitative, analytical, and organization skills.
- Proficient in chart review, clinical record information systems, and coding methodologies.
- Ability to understand and interpret medical records, hospital bills, and the ChargeMaster.
- Ability to understand all ancillary department functions.
- Excellent written and verbal communication skills.
- Excellent critical thinking skills.
- Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, and hospital management staff.
- Ability to work independently in a time-oriented environment.
- Computer literacy and familiarity with the operation of basic office equipment.
- Assertive personality traits to facilitate ongoing administration communication.
- Working knowledge of Medicare reimbursement system and coding structures preferred.
Pay
A reasonable compensation estimate for this role is $28.89 to $40.54 per hour. The exact starting compensation will be determined based on factors such as skillset, years of applicable experience, education, credentials, and licensure.
Benefits
The company offers a comprehensive, competitive benefits package that allows staff to customize their benefits to fit their unique needs. Benefits include abundant resources, programs, and voluntary options that serve as a foundation for individual growth and well-being.
Schedule
Full Time, Day Shift