Revenue Integrity Analyst Lead

Cheyenne Regional Medical Center•Cheyenne, WY

3d•Onsite

About The Position

The Revenue Integrity Analyst lead is responsible for contracting reimbursement, validates contract accuracy, analyzes and compiles information for all payments made to Cheyenne Regional to ensure payment accuracy in accordance to contracts and regulatory requirements. This position will lead and assist Reimbursement Coordinators/Specialists in ensuring the Independent Dispute Resolution (IDR) processes are followed and submitted timely. This position will collaborate with Revenue Cycle Departments, Finance, Epic, Compliance, and Legal with payor contracts and Charge Description Master (CDM) while reporting to the Revenue Integrity Administrator.

Requirements

Bachelor's degree or higher in Finance, Accounting, Healthcare Administration, or Business
Two (2) or more years of professional or facility billing or finance experience
6 Months: Certified Revenue Cycle Representative (CRCR) from Healthcare Financial Management Association (HFMA) within six (6) months of start date
Knowledge of federal and state billing and coding regulations, including billing compliance and issues
Knowledge of payor contracts and billing requirements, including government and commercial payors
Critical thinking and analysis skills
Knowledge of the revenue cycle
Ability to effectively analyze payor denials
Ability to identify performance improvement opportunities
Excellent verbal, written, and interpersonal communication skills
Knowledge of computer programs, including billing, document imaging, and Microsoft office products

Nice To Haves

Four (4) or more years of experience working with Health Insurance Payer Contracts
One (1) or more years of experience working with Independent Dispute Resolution (IDR) processes
Experience with medical terminology and coding

Responsibilities

Maintains library of all payer contracts and communications, coordinates with Legal to ensure that all renewal and expiration dates are accurate.
Assists in ensuring all contracts are tested and validated within Epic.
Audits information on processed claims in a timely manner to validate accurate reimbursement based on contractual guidelines, uses extensive knowledge of payor contracts and the ability to determine the appropriate reimbursement.
Utilizes databases to prepare and monitor claim denials, performs analysis of adjustments to accounts and determines accuracy, performs calculations to determine accuracy of payments based on contracts, fee schedules or other payment methodologies.
Maintains payer information and reviews commercial generic report for possible set up of new payers and updates payer information for any changes such as address, phone number, website.
Acts as the Charge Master Auditor within Epic, utilizing tools and applications (e.g. Revenue Guardian) ensuring charges are accurately documented and listed.
Analyzes historical and current revenue performance across services, carelines, channels, and payer segments to identify trends, variances, and key drivers of results.
Provides monthly payor scorecards to leadership.
Prepares and presents recurring and adhoc revenue reports, dashboards, payor scorecards, and insights for stakeholders to support operational and strategic decisions.
Monitors key revenue performance indicators including payer mix, denial trends and utilization metrics and escalate variances, risks, and opportunities with fact-based analysis and recommendations.
Verifies payer contract parameters ensuring all contract terms are met, to include paid clean claims, timeliness of claims and paid according to contracts.
Schedules payer calls, creates agendas and maintains minutes and action items.
Negotiates and approves of all single case agreements to include both Physician Billing (PB) and Hospital Billing (HB).
Follows lean methodology and assists with project improvement.