The Revenue Integrity Analyst determines the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding, by reviewing and analyzing the medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices. This review includes the verification of coding, 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, claims scrubber systems, or in the payer’s system. Revenue Integrity Analyst will coordinate to ensure optimum process towards maintaining a low DNFB by clarifying any process failures, i.e., clinical documentation deficiencies, late charge entry, IT technical issues, delays in scanning, indexing, analysis, etc. This position also serves as a liaison between facility administration, patient accounts and ancillary department directors, regarding charging issues, clinical documentation issues and revenue opportunities. Providing review results and developing and coordination educational in-services for facility staff related to charging/billing issues is also a key responsibility of this position. At times, this position may collaborate with the compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.Qualifications
EDUCATION, EXPERIENCE, TRAINING
1. Bachelor's degree in Healthcare, Business or related field is required.
2. Certification or license as a Certified Coding Specialist (C.C.S.), or Registered Health Information Technician (R.H.I.T.), or Registered Health Information Administrator (R.H.I.A.); required.
3. Experience with PCs, word processing, spreadsheet, Analytics, and database software applications is required.
4. Two years’ experience in a role related to revenue capture/charging, auditing, coding is required.
5. Successful completion of college level courses in medical terminology, anatomy, physiology, pathophysiology, and coding ICD-10 and CPT/HCPCS; required.
6. Use of an encoder software product for code assignment in an acute care setting; preferred.
7. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm; preferred.
8. Strong quantitative, analytical and organization skills.
9. Proficient in chart review, clinical record information systems and coding methodologies.
10. Ability to understand and interpret medical records, hospital bills, and the Charge Master.
11. Ability to understand all ancillary department functions.
12. Excellent written and verbal communication skills.
13. Excellent critical thinking skills.
14. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff and hospital management staff.
15. Ability to work independently in a time-oriented environment.
16. Computer literacy and familiarity with the operation of basic office equipment.
17. Assertive personality traits to facilitate ongoing administration communication.
18. Working knowledge of Medicare reimbursement system and coding structures preferred.
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf