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Revenue Integrity Analyst

Job ID: 4666635
Updated: August 10, 2018
Geographic Location: 
Department: Revenue Cycle Integrity
Full/Part Time: Full-Time
Shift: Days
Standard Hours: 40
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Job Summary

Revenue Integrity Analyst

This position is primarily responsible for all acute and non-acute Revenue Cycle analytical needs.  This includes the creation and maintenance of scorecards, dashboards, and ad hoc reporting using a variety of source systems and presentation software.  In addition, this position is required to provide analytical insight regarding all reports.  This position is responsible to discover root causes and to develop a corrective action plan.  Recommends modifications to established practices & procedures or system functionality as needed to support revenue cycle and then manages implementation of those recommended changes.  The analyst will work with internal customers to ensure newly implemented workflows and procedures, support revenue cycle integrity and to achieve revenue cycle’s financial goals.  The analyst participates in implementation of new & existing functionality to support revenue cycle processes.

Essential Functions & Responsibilities:

  • Daily review of charge items & Revenue Integrity work queues to ensure they are resolved accurately and in a timely manner to meet  the deadlines.
  • Analyze billed charges, medical records and related medical documentation to look for missing, incorrect or late charges.
  • Evaluate charge capture practices for their assigned facilities  to ensure accuracy & completeness of charge capture and compliance with government and non-government payers rules and regulations.
  • Follow up as appropriate when unusual items are noted and ensure problems are resolved and prevented in the future.
  • Maintain working knowledge of CPT and HCPCs coding as well all billing, CCI, MUEs, and other relevant coding/ billing guidelines.
  • Provide recommendation based on finding to improve charge capture workflows and to standardize charge capture practices.
  • Reports on trends, findings, and opportunities for improvement to managements detailing findings and high risk items that leaders should be monitoring, including missing, incorrect, and late charges.
  • Work closely with individual facilities representatives/clinical staff to establish and maintain positive relations to ensure revenue integrity goals are achieved.
  • Participate in onsite  meetings and interact on regular basis with site based  department leaders regarding changes in charge capture practice.
  • Performs database editing/auditing functions to maintain and/or improve data quality.

Knowledge, Skills & Experience Required:

  • Bachelor’s Degree or equivalent experience
  • 5 or more years of related experience desired
  • Excellent knowledge of Epic, Excel and SQL queries
  • Working knowledge of CPT & HCPCs coding guidelines
  • Excellent computer, proof reading, and written and verbal communication skills.
  • Excellent interpersonal skills including the ability to communicate effectively with CHP internal and external customer base.
  • Ability to work independently, proactively with limited supervision and also as a team player when called upon.
  • Ability to work under pressure.
  • Ability to maintain the security of confidential information.
  • 25% Travel

Hours

Full-time, 40 hours per week, days

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

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