Revenue Integrity Analyst II

Service Areas:Emergency/Trauma, Transport, Behavioral Health,

Transplant, Donor BMT, Sleep, EEG/EMG, Respiratory/PFT

Schedule: Monday - Friday from 8 AM - 5 PM (with some flexibility)

• Essential Functions

  Analyzes data, develops reports, reviews trends and recommends enhancements as defined by the revenue practice leadership team.Performs extensive data mining, mentoring/training, regulatory and payer policy review, abstracting of financial and clinical information from various sources.Presents, researches, and follows-up on topics reviewed at department and system-wide initiative levels.Monitors for positive or negative trends in coding, charge capture and/or editing processes to improve teams performance. Researches and stays current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits. Audits and evaluates system automation by comparing the charge/claim data to the clinical record. Leverages other system functionalities to expediate the claim processing for compliant and optimized hospital accounts. Evaluates, provides education and guidance to revenue cycle,

• revenue practice teams and clinical operations on report development, charge capture accountability and revenue monitoring.Mentors and supports the training of other revenue integrity analysts.

  Skills

  Data Analysis

• Healthcare RegulationsProcess improvement

• Health Insurance CMS Problem resolving DataMining Excel Collaboration

• Epic

• Qualifications

  Required

  Current certification through AAPC, AHIMA or HFMA, or other specialty medical coding group.

• Experience in a role requiring attention to detail with excellent organizational and analytical skills.

• Demonstrated proficiency with Epic clinical and/or billing applications.

• Demonstrates ability to be flexible and adaptable to change

• Demonstrates ability to work in a clinical operational area and/or a revenue integrity team effectively supporting department outcomes.

• Experience working closely with a multi-disciplinary team to optimize patient experience and operational success.

• Demonstrates advanced knowledge of regulation, payer policy, charge capture and/or revenue monitoring.

  Preferred

  Bachelor’s degree in healthcare administration, or medical, analytical field from an accredited institution. Education is verified. Proficient or certified with Epic clinical or billing applications.

  Physical Requirements

  Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.Frequent interactions with providers, colleagues, customers, patients/clients and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.