Revenue Integrity Analyst

Surgery Partners, Inc•Lubbock, TX

19h•Onsite

About The Position

Lubbock Heart & Surgical Hospital is committed to providing better outcomes for our employees! We are looking for a dedicated Revenue Integrity Analyst to join our Lubbock Heart team. This role involves interpreting reports, compiling data, and supporting revenue cycle workflows to ensure timely and accurate charge capture and billing. The analyst will audit payor denials, recoupments, and underpayments, as well as identify and manage patient credit balances. Collaboration with clinical and business departments is key to maintaining compliant business practices and implementing revenue cycle improvements. The position requires a strong understanding of EHR documentation standards, coding, billing updates, and Medicare regulations. The analyst will also provide support for HIM documentation functions and act as a resource for the entire Revenue Cycle operations. This role demands excellent analytical and communication skills, with the ability to present findings clearly and concisely. Maintaining a culture of compliance, ethics, and integrity is paramount, especially in the rate-setting process. The analyst will generate various reports, monitor charges, and research reimbursement practices to recommend charge capture changes. A detailed, patient account level analysis is expected, including root cause analysis. The role also involves assisting with the implementation of new charges, interacting with leadership regarding CDM compliance, processing patient refunds, and serving as a point of contact for escalated inquiries. The analyst will review and audit revenue processes for optimal performance and efficiency, assist with data analysis for charge capture efforts, and propose action plans for resolution. Working with Coding and other departments ensures revenue integrity in charge capture processes, and validation of revenue codes is crucial for accurate assignment and smooth billing workflows. The analyst will coordinate code assignments, work daily queues to resolve bill holds, and review claims held in charge and Discharged Not Final Billed applications. Assisting in maintaining contact lists and reporting findings from work queues, along with developing recommendations and corrective actions with the Performance Improvement team, are also key responsibilities. Support for remediation within third-party vendor software related to charge capture and revenue integrity is required. The role provides analytical support for process analysis, denial analysis, charge lag analysis, underpayment analysis, missing charge analysis, and other aspects of the revenue cycle. Other duties as assigned by management.

Requirements

An Associate’s Degree
Three years of experience in revenue cycle or data analysis
At least one year of experience in both facility and provider billing and coding
Experience with Cerner
Coding Certification
Excellent written and communication skills with the ability to write, present, and explain recommended materials in a clear, concise and organized format.
Proven analytical skills.

Responsibilities

Interpret accurate reports, compile data and work papers to support revenue cycle workflows to assist with timely and accurate charge capture and billing.
Audit, identify, and trend payor denials, recoupments, and underpayments.
Audit and identify patient credit balances and take appropriate action in the payment and billing systems.
Work with clinical and business system development and maintenance of data.
Work collaboratively with all departments to assist in compliant and appropriate business practices.
Perform Charge Capture reviews, audits and research.
Be a resource for the entire Revenue Cycle and its operations.
Identify gaps in processes, recommends solutions, and assists Director of Revenue Cycle Management in implementation of revenue cycle improvements.
Perform reviews and analysis of documentation in EHR and provides education to ensure appropriate document standards according to Medicare standards.
Provides backup support for HIM documentation functions.
Educate clinical department and providers on quarterly coding and billing updates.
Support different computer systems including Cerner.
Maintain a culture of compliance, ethics and integrity especially in the rate-setting process.
Generate reports, monitors charges, discharged not final billed, work queues, denial reports, other revenue cycle related reports to assist management and revenue cycle team in the timely charge capture and billing efforts.
Research and analyze reimbursement practices, compiles data in an organized format and makes recommendations on charge capture changes.
Research and monitor codes on services, procedures, supplies, injections, medications and modifiers.
Exhibit and maintains an understanding and application of CPT, HCPCS and CMS regulations and guidelines.
This detail level analysis involves root cause analysis and entails looking at patient account level detail.
Assist with implementation of new charges and meet with departments as needed.
Interact with leadership, department managers and facility staff regarding CDM compliance and related financial issues.
Research and processes patient refunds.
POC for escalated in-person and phone inquiries.
Review and audit revenue processes and charge capture effectiveness to facilitate optimal performance and efficiencies.
Assist with data analysis and research for any and all charge capture efforts. Propose action plan for resolution of issue as it pertains to charge capture/CDM.
Works with Coding and all other departments to ensure revenue integrity in charge capture processes.
Validate UB revenue codes, type of service codes to ensure accurate assignment and smooth workflows on billing forms.
Coordinate assignment of codes.
Work daily work queues to resolve - bill holds - for charge related issues assigned to the revenue integrity unit in the charge and work queues.
Daily review of claims held in charge and Discharged Not Final Billed applications. Distribution of these charges related issues to the proper department.
Assist in maintaining the HB Charge Contact list for distribution to billing, coding and PFS groups.
Assist with report findings from the assigned work queues, erroneous or missing charge postings with following up analysis, development, and implementation of recommendations and actions plans to minimize late or missing charges.
Work with the Revenue Cycle Director to document and report findings and work with Performance Improvement team to develop recommendations and corrective actions.
Support the remediation process within third part vendor software to the extent they relate to charge capture and revenue integrity concerns.
Assists with analytical support to: process analysis, denial analysis, charge lag analysis, underpayment analysis and missing charge analysis and all other aspects of revenue cycle.
Performs other duties as assigned by management.