Rev Integrity Analyst 2 - CL / Revenue Cycle Cmdr Coding

Hartford Healthcare•Farmington, CT

About The Position

This position contributes to and supports Revenue Integrity's mission by creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and the charge improvement process. It is an integrated approach that guides the Hartford HealthCare (HHC) organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. This role supports HHC outpatient departments, including hospital services for a variety of revenue-generating clinical departments. Under the direction of the Revenue Integrity Analyst II, this position plays a key role in improving revenue results. This position is integral to the Revenue Integrity Team to assist in ensuring charging accuracy for patient services and appropriately coded information supported by clinical documentation so the related revenue is recorded in the proper department. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed. This position is responsible for assisting Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with the resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.

Requirements

Minimum: Bachelor’s degree with health management or financial emphasis and/or health services
Minimum: Ten (10) years of progressive on-the-job coding and health care experience in an acute care hospital
Minimum: Certified Coder, (CCS, CPC, etc.)
English - Strong written and verbal communication skills
Requires the ability to manage large complex projects assignments, investigate, analyze, and resolve issues at an important level.
Excellent communication, presentation, organizational, analytical, and critical thinking skills.
Must approach problem-solving challenges independently, have strong attention to detail and enjoy working in a fast-paced, collaborative team-based environment.
Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, and Ras.
Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10.
Extensive knowledge of NCCI edits, and Medicare LCD/NCDs.
Extensive understanding of reimbursement theories to include OPPS, MPFS, and managed care.
Extensive working knowledge of health care compliance.
Extensive understanding of medical terminology, anatomy, and physiology along with clinical department activities.
The ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with assistance for all member entities.
The ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership, and other billing personnel.
Read, write, and speak English proficiently.
Strong analytical capabilities.
Excellent organizational skills.
Proficiently read and interpret physician writing.
Strong ability to function independently.
Strong ability to manage multiple priorities.
Strong ability to listen and acknowledge ideas and expressions of others attentively.
Strong ability to converse clearly using appropriate verbal and body language.
Strong ability to collaborate with others to achieve a common goal through cooperation.
Strong ability to influence others for positive and productive outcomes.
Strong ability to utilize coding subject matter expertise to support new specialized coders and other projects.
Strong ability to work across the Hartford HealthCare System.
MS Office includes Word, PowerPoint, Excel and Outlook, Windows operating system, and the Internet.

Nice To Haves

Preferred: Bachelor’s Degree or equivalent Healthcare experience
Preferred: Certified Healthcare Revenue Integrity (CHRI)

Responsibilities

Contributes to and supports Revenue Integrity's mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and the charge improvement process.
Under the direction of the Revenue Integrity Manager, plays a role in improving revenue results.
Evaluates current charging and coding structures and processes in revenue-generating departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms, and other charge documents used to capture revenue.
Assists Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise.
Participates in external audit requests and special projects as needed.
Performs denial resolution by analyzing denial data to identify root causes of preventable denials, develop and implement corrective action plans to address root causes, including collaborating with clinical areas and other departments within revenue cycle.
Optimizes revenue cycle processes by validating, evaluating, and trending substantial amounts of data for presentation to all levels of the organization.
Serves as an audit outcome educator with clinical staff in clinic and department settings.
Performs regular charge audits, identifying any trends, and implementing corrective actions when appropriate, reporting to the Revenue Integrity Manager.
Provides guidance, communication, and education on correct charge capture, documentation, coding, and billing processes.