Revenue Integrity Analyst Sr

About the role

This position partners with various departmental staff and physicians: Patient Financial Services (PFS), Case Management (ICM), Health Information Management (HIM), Corporate Compliance, Surgery, Nursing, Physicians, Outpatient Procedural Departments, Reimbursement, and Internal Audit. Serves as a primary resource and educator to these departments for appropriate patient status, charge capture, coding, billing, medical necessity, Medicare rules, and payment methodologies. Leads and participates in various Revenue Cycle committees, appeals processes, and contributes to changes which improve overall compliance and improve revenue recognition.

Responsibilities

Serves as a primary resource and educator to various departments for appropriate patient status, charge capture, coding, billing, medical necessity, Medicare rules, and payment methodologies. Leads and participates in various Revenue Cycle committees, appeals processes, and contributes to changes which improve overall compliance and improve revenue recognition. Provides excellent customer service and has a high degree of autonomy.

Requirements

Require coding certification from the American Health Information Management Association or American Academy of Professional Coders within one (1) year of hire date. Require a minimum of three (3) years of strong training and background in coding and reimbursement. Require demonstrated knowledge of Medicare, Medicaid, Medicare OPPS reimbursement and third party billing rules and coverage. Require demonstrated knowledge of medical necessity rules and Medicare inpatient only list.

Preferred Qualifications

Prefer previous auditing experience. Prefer demonstrated proficiency in verbal and written communication. Prefer demonstrated ability to relate well to others in a variety of functional areas, handle multiple responsibilities simultaneously and to problem-solve and think both creatively and analytically.