Revenue Integrity Senior Analyst - HMFP

Job Description

Primary Responsibilities

• Maintain departments' adherence to professional charge reconciliation, work-queue, and professional coding quality expectations.
• Support departments with education, process improvement, and follow-up.
• Conduct periodic departmental reviews of professional charge reconciliation processes.
• Document and route changes within the charge description master (CDM) and fee schedule(s).
• Lead annual, quarterly, and regular CDM and fee schedule maintenance activities.
• Review and verify changes in CPT, HCPCS, and wRVUs.
• Support departments with analyzing services for coverage and reimbursement.
• Identify and address revenue management opportunities.
• Develop, deliver, and revise revenue integrity and coding education and training programs.
• Monitor, investigate, and report revenue integrity and coding quality concerns.
• Stay updated with regulatory and legislative changes and tailor the revenue integrity program accordingly.
• Monitor coder quality audit results and coder productivity.
• Lead assigned revenue integrity and coding projects, committees, and meetings.
• Develop and execute tools and processes to identify potential areas of delayed or lost revenue.
• Build strong relationships and facilitate effective communication between key stakeholders.
• Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken.

Required Qualifications

• Bachelor’s degree required.
• Certification: Certified Professional Coder (CPC) required.
• 5 or more years physician/professional revenue operations experience with a focus in one or more of the following areas: coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, CDM management.
• EPIC PB experience preferred.
• Extensive knowledge of:
• Revenue cycle processes and physician billing
• Code sets to include Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS), and International Classification of Diseases (ICD-10)
• Reimbursement theories to include RBRVUS, MPFS, and managed care
• NCCI edits and Medicare LCD/NCDs
• Health care documentation, coding and billing requirements as well as federal and state health care regulatory requirements
• Health care compliance
• Medical terminology, anatomy and physiology along with clinical department activities.
• Abilities:
• Manage large complex projects assignments, investigate, analyze and resolve issues at a high level.
• Excellent communication, presentation, organizational, analytical and problem-solving skills. Must communicate effectively with physicians, leadership, and other billing personnel.
• Approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment.
• Advanced skills with Microsoft Office, including Outlook, Word, Excel, PowerPoint, Power BI and other web-based applications. Ability to produce complex documents.
• Strong analytical ability. Skills to collect, organize and analyze data, produce actionable reports, and recommend improvements and solutions.

Social/Environmental Requirements

• Work requires periods of close attention to work without interruption.
• Work requires constant response to changing circumstances and using new information to adjust approach and to quickly respond to new needs.
• No substantial exposure to adverse environmental conditions.
• Health Care Status: NHCW: No patient contact. Health Care Worker Status may vary by department.

Sensory Requirements

• Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity> 20 feet, Visual clarity feet, Conversation, Telephone.

Physical Requirements

• Sedentary work: Exerting up to ten pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.
• This job requires constant sitting, Keyboard use. There may be occasional walking, standing.

Pay Range

$55,370.00 USD – $74,110.00 USD