Revenue Integrity Analyst

Revenue Integrity Analyst

Position Summary

It is the Revenue Integrity Analyst's responsibility to assist and complete functions / job responsibilities to ensure timely, compliant, and accurate capture of charges and correct claims to various payers including governmental and non-governmental payers. The Revenue Integrity Analyst does this by resolving pre-bill claim edits and Meditech account checks; reviewing and entering accurate charges; completing charge corrections; monitoring, tracking, reporting claims and / or charge capture trends; . The Revenue Integrity Analyst must be knowledgeable and stay current with Centers of Medicare and Medicaid (CMS) regulations and managed care / commercial payer requirements and changes. The Revenue Integrity Analyst must apply billing and coding knowledge to complex claim scenarios in order to resolve those in a compliant, accurate manner. Completes projects and other tasks as assigned by department Director or designee.

Education

Associates Degree - Required (Healthcare Preferred)

Medical Terminology - Required

Courses in computer technology, spreadsheets / project management, medical billing, and medical coding - Preferred

Experience

2 Years hospital revenue cycle charging, claims processing, professional and or hospital healthcare billing, denials management or related revenue cycle / financial experience - Required

Knowledge of hospital billing & claim requirements, charge capture processes, CPT codes, modifiers, and other claims data, electronic record documentation and payer requirements including Medicare guidelines for documentation, charge capture, billing, and claims processing - Required

Effective problem solving and attention to detail - Required

Proficient in basic Excel, Word and PowerPoint – Required

Experience with CPT / HCPCS coding, claims preparation, MUE and NCCI claims edits - Preferred

License & Certification

Certified Professional Coder (CPC) or similar coding certification through accredited organization such as AAPC or AHIMA or Certified Revenue Cycle Professional / Specialist (CRCS) or Certified Revenue Cycle Representative (CRCR) through AAHAM or HFMA respectively – Required or must be obtained within one year of hire date.

Core Job Functions

• Reviews and resolves pre-billing claim edits including National Correct Coding Initiative (NCCI), Medical Unlikely (MUE), and other assigned claim clearinghouse edits daily. Ensures charges and related items are compliant and accurate.
• Completes manual charge entry and patient account reviews as assigned. This can include charge entry and pre-billing auditing of emergency department visits & procedures, outpatient IV infusion and injection charges, blood administration charges and other inpatient, outpatient or observation patient services / charges of SJ / C.
• Resolves account checks in Meditech daily to ensure timely submission of claims to payers including government and non-governmental payers.
• Identifies charge capture trends and claim edit trends to Revenue Integrity leadership and provides analysis and suggestions on possible solutions to improve clean claims submitted.
• Researches and communicates payer updates and changes to department, revenue cycle and clinical / service areas as appropriate. Research includes review and monitoring of assigned payer websites, newsletters, and other modes of communication. Participates in payer / managed care contract payer meetings to assist denials management and other revenue cycle leaders focusing on reducing of avoidable denials.
• Assists co-workers in the department with other daily or weekly responsibilities as assigned including resolution of Meditech account checks, patient account tasks, floor charges, quality report exceptions, and other items as assigned.
• Completes charge audits to include post-claim reviews in the Trisus Claims Informatics tool, and other tools. May be assigned other duties to support timely, compliant and accuracy billing of patient services / charges.

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