Revenue Integrity Analyst

Prime Healthcare Management Inc • Riverdale, GA

1d

About The Position

Prime Healthcare is an award-winning health system headquartered in Ontario, California, operating 54 hospitals and more than 360 outpatient locations across 15 states, serving over 3 million patients annually. With more than 60,000 employees and physicians, it is one of the nation’s leading health systems. The Revenue Integrity Analyst is responsible for ensuring the accuracy and appropriateness of patient charges. This involves reviewing medical record documentation against the Charge Description Master (CDM) and assigned HCPCS/CPT coding, itemized bills, clinical procedures, and facility protocols. The role includes verifying coding, charging, and billing data for accuracy, completeness, and compliance with regulatory requirements, and resolving any edits or exceptions identified during claim processing in patient accounting systems, claims scrubber systems, or payer systems. The analyst also works to maintain a low Denials Not Final Billed (DNFB) rate by addressing process failures such as clinical documentation deficiencies, late charge entry, or IT-related technical issues. This position acts as a liaison between facility administration, patient accounts, and ancillary department directors regarding charging issues, clinical documentation, and revenue opportunities. Key responsibilities also include providing review results and developing educational in-services for facility staff on charging/billing issues. Collaboration with the Compliance Analyst for various billing audits may also be required.

Requirements

• Bachelor's degree in Healthcare, Business, or related field is required. (Combination of education and experience is also acceptable)
• Two years’ experience in a role related to revenue capture/charging, auditing, coding is required.
• Strong quantitative, analytical and organization skills.
• Proficient in chart review, clinical record information systems and coding methodologies.
• Ability to understand and interpret medical records, hospital bills, and the Charge Master.
• Ability to understand all ancillary department functions.
• Excellent written and verbal communication skills.
• Excellent critical thinking skills.
• Ability to work independently in a time-oriented environment.

Nice To Haves

• Epic proficiency in Hospital Billing
• Use of an encoder software product for code assignment in an acute care setting
• Working knowledge of Medicare & Medicaid reimbursement system and coding structures

Responsibilities

• Determines the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding, by reviewing and analyzing the medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices.
• Verification of coding, charging and billing data for accuracy and completeness and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, claims scrubber systems, or in the payer’s system.
• Coordinate to ensure optimum process towards maintaining a low DNFB by clarifying any process failures, i.e., clinical documentation deficiencies, late charge entry IT related technical issues, etc.
• Serves as a liaison between facility administration, patient accounts and ancillary department directors, regarding charging issues, clinical documentation issues and revenue opportunities.
• Providing review results and developing and coordinating educational in-services for facility staff related to charging/billing issues.
• May collaborate with the Compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.

What This Job Offers

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