Revenue Integrity Analyst II

Thomas Jefferson University • Philadelphia, PA

1d

About The Position

PRIMARY FUNCTION : Works to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices. Responsible for collaborating with Revenue Cycle and clinical departments to ensure accurate and thorough high level analysis of governmental and commercial payer regulations related authorization, coding and billing guidelines. Maintains current knowledge regarding coding guidelines, changing/billing regulations and regulatory agency activities. ESSENTIAL FUNCTIONS: Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Primary clinical service-line liaison regarding payor guidelines, explaining regulatory requirements, and ensuring accountability and solid charge workflows for revenue integrity. Serves as the subject matter expert for clinical departments on issues related to revenue cycle. Identifies charge edit trends based on documentation, coding or charging issues and recommends workflow opportunities. 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. Serves as the service-line liaison between Revenue Cycle and clinical department administration regarding revenue, regulatory, · Develops processes to modify existing charge capture applications to reduce charge-related claim edits/rejections. · Advises service-line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines. · Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges. · Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings. · Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management. · Assists in the development and implementation of effective chargemaster review, education and training.

Requirements

• Bachelor's or Associate’s degree in Health Information Management, Business Administration, Accounting, Management, Healthcare Administration.
• Must hold and maintain one or more of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
• Five years experience in a hospital setting or within the healthcare industry strongly preferred.
• 1 – 3 years of experience related to auditing and/or coding is required.
• Knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.
• Understanding of various reimbursement systems including IPPS, OPPS and fee schedule.
• Strong oral and written communication skills.
• Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations.
• Ability to document clinical workflows impacting revenue cycle.
• Strong written communication, presentation skills, and excellent customer service skills.
• Excellent organizational and project management skills.
• Strong time management, attention to detail, and follow through.
• Motivated individual who can mentor and inspire in a team environment.

Nice To Haves

• Applicable professional certifications from American Association of Healthcare Administrative Management (AAHAM) or Healthcare Financial Management Association (HFMA) preferred.

Responsibilities

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Primary clinical service-line liaison regarding payor guidelines, explaining regulatory requirements, and ensuring accountability and solid charge workflows for revenue integrity.
• Serves as the subject matter expert for clinical departments on issues related to revenue cycle.
• Identifies charge edit trends based on documentation, coding or charging issues and recommends workflow opportunities.
• 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.
• Serves as the service-line liaison between Revenue Cycle and clinical department administration regarding revenue, regulatory,
• Develops processes to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Advises service-line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines.
• Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges.
• Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings.
• Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management.
• Assists in the development and implementation of effective chargemaster review, education and training.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees