Revenue Integrity Analyst

The Revenue Integrity Analyst is responsible to monitor investigate and resolve revenue integrity concerns and violations identified by the Revenue Integrity Department or by other departments.Analyst will monitor national state and local information to keep current with applicable regulatory and legislative changes.

Resolve work queue holds and discharge not billed errors for common coding & billing issues such as National Correct Coding Initiative (NCCI) Medicare Outpatient Code Editor (OCE) Center for Medicare & Medicaid Services edits payor edits device to procedure and modifier edits.Review accuracy of CPT-4 HCPCS ICD-9 procedure and diagnosis codes for resolution of edits.Provide feedback to the Manager of Revenue Integrity and Coding Leadership on volume of these issues to enhance system edits and drive automation to resolve edits upfront and prevent billing delays.Review outlier or excessive charges as well as charge issues that may lead to reimbursement issues denials or incorrect billing.

Payor & Plan Master Files in Epic

Analyst will validate build and review payor listings periodically to ensure that listings are in sync with the needs of Contracting Decision Support (reporting purposes) Registration and Patient Financial Services.

Charging Audits

Responsible for ad hoc projects to review charges and ensure that they are being applied appropriately and as intended.Charging audits will include pharmacy items particularly medications subject to 340B.Will aid with 340B audits for modifier and claim detail.Will work with Denials Team on NDC / unit/ and charge issues with third party payers related to pharmacy charges.Will assist when Coding Validators identify trends in incorrect charges and the Refund Policy is required or claim corrections are necessary.When charging issues are identified; run reports and open service requests to prevent the continuation of issue. Ensure that charges for pass-through devices and drugs and drug waste charges etc are applied to ensure maximum appropriate reimbursement.

Follow-up and review charges for new departments and new projects to ensure that Epic build is working appropriately.

Suggest and assist in setting up charge review holds claim edits and revenue guardian checks etc in LifeChart to ensure compliant charging.

Chargemaster Support

Analyst will review requests from Patient Financial Services for Chargemaster (both hospital & professional billing) updates related to payor policies or general findings from the denials team.Analyst will review the request report on charge and claims data and ensure the update is needed as well as follow-up on payor related Chargemaster changes to ensure the change is effective.

Projects

Affirmatively promotes project objectives direction and achievements fostering collaboration and teamwork and acting as a positive resource for all team members.Assists in coordinating communications within and among multi-disciplinary teams vendor representatives project leadership users and other stakeholders.

Develop recommendations for changes to operations which result in automated solutions that are logical economical practical and responsive to needs of users.

Performs other related duties as required.

High School Diploma required Associate Degree or preferred or equivalent experience.

Coding certification preferred from the American Health Information Management Association (AHIMA [RHIA RHIT CCA CCS or CCS-P] or the American Academy of Professional Coders (AAPC) [CPC or CPC-H] or strong experience in Revenue Cycle experience specializing in billing and follow-up. Requires knowledge of payor policies chargemaster hospital & professional payor reimbursement LCD and NCDs modifiers and 837 INP files.

EXPERIENCE:

At least five years of experience in healthcare with a heavy emphasis in one of the following areas:Billing and follow-up Coding Hospital and Physician Revenue Cycle.Proficient in Microsoft Office specifically MS Excel Outlook and PowerPoint and Epic.Highly organized with strong project management skills including the ability to meet deadlines effectively communicate with all levels of the organization and work as part of a team.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Work is performed in a typical office setting.

INDEPENDENT ACTION:

Ability to work with minimal supervision.Proactive approach to the resolution of problems issues etc.Performs independently within department policies and practices.Refers specific complex problems to manager where direction may be required.

SUPERVISORY RESPONSIBILITY:

None