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Revenue Integrity Analyst

Orthopedic ONE

Westerville, OH

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JOB DETAILS
SKILLS
Analysis Skills, Automation, Billing, Chargemaster, Clinical Information, Communication Skills, Cross-Functional, Current Procedural Terminology (CPT), Data Analysis, Data Mining, Data Modeling, Data Quality, Data Sets, Database Programming, Document Management, Electronic Medical Records, Fee Schedule, Finance, Health Insurance, Healthcare, Healthcare Administration, Healthcare Common Procedure Coding System (HCPCS), Human Anatomy, Identify Issues, Information Technology & Information Systems, International Classification of Diseases (ICD), Leadership, Maintain Compliance, Medical Billing, Medical Records, Medical Terminology, Metrics, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Multitasking, Operational Audit, Operational Support, Orthopedics, Performance Analysis, Performance Metrics, Policy Implementation, Precision Testing, Presentation/Verbal Skills, Pricing, Problem Solving Skills, Procedure Implementation, Process Improvement, Project/Program Management, Query Analysis, Reimbursement, Reporting Dashboards, Reporting Skills, Revenue Analysis, Risk Management, Root Cause Analysis, SQL (Structured Query Language), Staff Training, Standard Operating Procedures (SOP), Statistics, Trend Analysis
LOCATION
Westerville, OH
POSTED
7 days ago
Candidates must live in Ohio permanently. This position is eligible for a hybrid work arrangement after completion of a 90-day introductory period

Position Summary:Under the direction of the Director, Patient Accounts, the Revenue Integrity Analyst will ensure accurate and compliant healthcare billing by analyzing claims, resolving errors, managing the charge master, identifying denial root causes, educating staff and optimizing revenue cycle capture and financial performance. Position requires maintaining strict confidentiality of all data and information as the position will have access to business sensitive or confidential information including patient clinical or financial information. The individual selected for this role will work closely with the Director, Patient Accounts to develop analytics solutions that align with Orthopedic One's strategy and vision. Work include SQL development, data analysis, data mining, and data validation. Responsibilities/Accountabilities:

Reporting and Analysis:
  1. Analyze key performance indicators (KPI's) revenue cycle metrics identifying trends, creating and maintaining reports and dashboards for leadership and performing root cause analysis on revenue cycle issues.
  2. Ensure the prevention of payment denials and claim resolution by investigating and correcting claim edits, denials, holds and system edits and billing rules set up.
  3. Charge Master Management (CDM): Overseeing charge master accuracy, testing updates and integrating new services. Updates CPT, HCPCS and revenue codes to ensure accurate pricing and billing transparency.
  4. Utilize variance tools to analyze fee schedules, identify overpayments or underpayments and work closely with payer contracts to ensure compliance.
  5. Determine appropriate methods to analyze operations, relevant information, and data. Create new queries and analysis tools, develop databases as needed and acquire desired data.
  6. Interprets results, identifies trends, and provides director with business insights and performance metrics using data analysis methods and modeling.
  7. Education, Compliance & Auditing: Provide training and resources to clinical and billing staff on proper charging and documentation practices.
  8. Performs analysis on an ad hoc basis as required to support the operational needs of the Patient Accounts Department.
  9. Able to communicate effectively (written and verbal) the findings of analyses and audits to support operation and financial decisions.
  10. Acts a local support and super user in systems including EMR, clearinghouse and variance denials tools, working with all levels of associates to identify issues and root causes and make recommendations for process improvements.
  11. Provide project management support for leadership. Leads implementation plans to ensure stability of workflows and solutions.
  12. Assist in the development/coding, implementation and management of automation reports, dashboards, and other SQL-based analytics tools used for revenue cycle and other critical business functions.
  13. Create and manage documentation (such as SOPs and data dictionaries) for various data solutions, reports, and dashboards.
Teamwork:
  1. Works cooperatively with coworkers, providers, and management.
  2. Shares knowledge and insights with co-workers in a constructive manner.
  3. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
  4. Addresses conflicts with person directly before involving manager or uninvolved peers.
  5. Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.
Policies and Procedures:
  1. Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
  2. Provides assistance and support to leadership in implementing policies and procedures as necessary.
  3. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

Education, Experience, and Certification/Licensure Required:

A bachelor's or associate degree in Healthcare Administration, Finance, Health Information Systems, Statistics, or a related field is required. A combination of relevant education, training, and experience may be considered in lieu of a degree.

A minimum of three years of professional experience, preferably in a healthcare setting, is required. Experience should include working with large datasets, developing complex queries and analyses, managing multiple projects, and preparing reports and presentations within a multidisciplinary team environment.

This role requires a strong understanding of medical terminology, human anatomy, ICD'10/CPT coding, and medical insurance reimbursement models.

Candidates must demonstrate proficiency with Microsoft Office applications, including Excel, Teams, and PowerPoint. SQL experience is preferred.

Excellent communication, analytical thinking, facilitation, problem'solving, and project'leadership skills are essential.

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About the Company

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Orthopedic ONE