Charge Review Analyst - Revenue Integrity - Full Time

LCMC Health

About The Position

Your job is more than a job GENERAL DUTIES: Collaborate with Charge review Coordinators and Charge Review Specialist to monitor charge capture functions across all LCMC entities. Conducts thorough reviews of patient charges to ensure services provided are accurately captured and billed. Verify the correct usage of procedure codes (CPT/HCPCS) and diagnosis codes (ICD-10) to ensure charges align with clinical documentation. Identify and investigate charge discrepancies, missing charges, or incorrect coding, and work with relevant departments to resolve issues. Serve as a resource for charge integrity specialists and departments on charge-related inquiries, providing support and guidance on proper charge capture practices. Provide feedback and training to clinical departments on charge capture issues and regulatory changes that impact billing and coding with oversite by the charge review coordinator. Educate on best practices for documentation and charge entry to enhance revenue capture and compliance. Prepare and present reports on charge review findings, highlighting areas of improvement and compliance risks. Monitor key performance indicators (KPIs) related to charge capture accuracy and timeliness. Create action plans when KPI’s are above target. Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements. Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. Monitors EPIC Revenue Integrity Dashboard(s) and Ri assigned work queues to assist in completion and timeliness of completion meeting Revenue Integrity Department standards. Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity. Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, charge capture navigators, and other charge components. Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. Train and assist in daily resolution of revenue integrity edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation. Performs miscellaneous duties as assigned. Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes. Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders. Excellent organizational and project management skills. Strong time management, attention to detail, and follow through. Well-developed research skills. Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively. Work effectively as a team contributor on all assignments. Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations. Delivers positive patient experience, where applicable.

Requirements

Minimum: 3 years' experience in the hospital setting, healthcare industry, revenue cycle or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management.
Minimum: High school diploma or GED with equivalent combination of certification and experience is required.
Applicable professional certification through AHIMA (RHIA, RHIT, CCS), RN, LPN or AAPC (COC, CPC) or Epic Certified
Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500.
Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10.
Advanced knowledge of NCCI edits, and Medicare LCD/NCDs.
Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care.
Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical –thinking and the ability to meet deadlines while influencing, but not directly managing the work of others.
Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Nice To Haves

Preferred: EPIC HB/PB experience
Preferred: Associate’s degree in healthcare administration, Health Information or related field is preferred.

Responsibilities

Collaborate with Charge review Coordinators and Charge Review Specialist to monitor charge capture functions across all LCMC entities.
Conducts thorough reviews of patient charges to ensure services provided are accurately captured and billed.
Verify the correct usage of procedure codes (CPT/HCPCS) and diagnosis codes (ICD-10) to ensure charges align with clinical documentation.
Identify and investigate charge discrepancies, missing charges, or incorrect coding, and work with relevant departments to resolve issues.
Serve as a resource for charge integrity specialists and departments on charge-related inquiries, providing support and guidance on proper charge capture practices.
Provide feedback and training to clinical departments on charge capture issues and regulatory changes that impact billing and coding with oversite by the charge review coordinator.
Educate on best practices for documentation and charge entry to enhance revenue capture and compliance.
Prepare and present reports on charge review findings, highlighting areas of improvement and compliance risks.
Monitor key performance indicators (KPIs) related to charge capture accuracy and timeliness.
Create action plans when KPI’s are above target.
Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
Monitors EPIC Revenue Integrity Dashboard(s) and Ri assigned work queues to assist in completion and timeliness of completion meeting Revenue Integrity Department standards.
Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity.
Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, charge capture navigators, and other charge components.
Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
Train and assist in daily resolution of revenue integrity edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation.
Performs miscellaneous duties as assigned.
Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders.
Excellent organizational and project management skills.
Strong time management, attention to detail, and follow through.
Well-developed research skills.
Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
Work effectively as a team contributor on all assignments.
Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
Delivers positive patient experience, where applicable.