Revenue Integrity Analyst

SouthEast Alaska Regional Health Consortium (SEARHC)•Juneau, AK

4d•$32 - $45

About The Position

The Revenue Integrity Analyst is responsible for improving charge capture, reimbursement, and revenue-cycle quality by supporting and managing revenue-cycle applications, process automation, the Charge Description Master, claims, analysis and reporting, clinical and departmental integration, and compliance, contract payment, and denials auditing. The role optimizes and troubleshoots applications, analyzes workflows and data, and works with clinical, operational, supporting departments, and other stakeholders to develop integrated solutions. It also supports patient revenue-generating departments and providers through education and guidance to promote appropriate charge capture.

Requirements

Bachelor's degree or equivalent combination of education and/or work experience; four years of work experience may be exchanged for a bachelor's degree.
At least two years of experience in Revenue Cycle, Finance, or a clinical capacity.
Knowledge of end-user workflows, including scheduling, registration, clinical and ancillary workflows, coding, billing and claims processing, cash posting, and/or reporting.
Knowledge of national and international code sets, including ICD-10-CM, DSM, CPT, HCPCS, Revenue Codes, CARC/RARC, and NCCI.
Knowledge of payer edits, rejections, rules, and appropriate resolution actions and requirements.
Knowledge of billing, accounts receivable, collection practices, and/or reporting requirements for IHS, CAH, FQHC, Provider Based, LTC, Rehab, Behavioral Health (CBH, SUD, 1115), and/or Retail Pharmacy enrollments.
Knowledge of file structure, configuration, requirements, and troubleshooting for UB-04, CMS-1500, 837I/P, 835, and/or NCPDP D.0.
Knowledge of resources, references, and statutes governing instructions, policies, and procedures for participation in and billing for various State, Federal, and Commercial programs.
Critical-thinking skills, including problem solving and troubleshooting.
Ability to design and execute creative solutions to complex problems.
Exposure to Microsoft Office programs, including Word and Excel.
Experience with electronic health record applications.
Ability to work on multiple projects in a fast-paced environment, multitask, and manage overlapping commitments and deadlines appropriately.
Ability to use a systematic, self-motivated approach to problem solving.
Ability to work independently and collaboratively as needed.

Nice To Haves

AAHAM, AAPC, AHIMA, PTCB, or other professional certification or licensure.

Responsibilities

Optimize and troubleshoot revenue-cycle applications.
Collaborate with clinical, operational, and supporting departments and relevant stakeholders to develop integrated design solutions.
Analyze available data to support Revenue Cycle initiatives, including identifying and defining system or user deviations, inconsistencies, and process failures and planning and implementing resolutions.
Serve as an internal resource on topics including registration, authorizations, coding, CDI, CDM management, claims, edits, billing compliance, denials, remittance processing, and reporting and analytics.
Analyze workflows.
Analyze payer contracts and ensure payments are consistent with negotiated contracts.
Identify root causes of controllable denials and partner with finance leadership to address related operational and workflow issues and training gaps.
Perform quality assurance and validation tasks.
Provide education and guidance to patient revenue-generating departments and providers to ensure appropriate charge capture.