Remote - Revenue Integrity Analyst

Mosaic Life Care

8d • $54,038 - $81,058 • Remote

About The Position

As part of the Revenue Integrity department, this position is responsible to identify and correct the processes and systems that leads to lost revenue opportunities and reduced reimbursement for the care provided to patients. As part of ensuring operational integrity of the charge posting processes the position performs and reviews regular audits that supports the maintenance and enhancement of Mosaic Life Care’s charge capture, compliance and billing functions. In addition, the position explores potential charge capture workflow enhancements, the application of a consistent charge structure and reviews rate setting, according to industry standards, payer contracts, and denial trends. The position ensures that charges make it to billing by working with the departments and Technical Services to monitor that processes are in place to handle charge interface exceptions that might turn into lost revenue. The role may also be involved in the design and implementation of data extraction and analytics processes across departments and service lines that helps pinpoint potential revenue leakage. The position maximizes charge efficiency through: (1) Monitoring revenue cycle processes and staff functions; (2) Supporting Mosaic Life Care’s revenue capture and integrity through evaluating the accuracy of charge capture and billing functions and staying apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of charge capture/billing workflow improvements. Performs other duties assigned. This position is employed by Mosaic Health System.

Requirements

• Bachelor’s degree in finance; business, health, or public administration management; or related field required.
• Three years experience in hospital charge capture review, medical record review, and claims auditing, and in working with regulatory and policy compliance issues related to federal and state programs required.
• Two years of coding experience required.

Nice To Haves

• Clinical review experience is a plus.

Responsibilities

• Through continuous process improvement efforts, works to ensure that every legitimate charge for services provided makes it to billing and that proper reimbursement is received for those services
• Works with the departments and Technical Services to ensure the flow from the department’s charge capture process to billing is error free and all charges from the departments are making it to billing
• Responsible for finding root cause reasons and proposing solutions for issues leading to revenue leakage and/or reduced reimbursement
• Assists in overseeing Mosaic’s charge capture system to promote its accuracy and integrity across revenue-generating departments
• Works with Patient Financial Services (PFS) to review items routinely being held by the claim scrubber that are charge/coding related and comes up with recommended resolutions that helps expedite cash flow; Liaison to PFS to review denials that are charge/coding related and with Contracts if payers are not paying as expected based on contract terms due to charge/coding issues
• Summarizes hospital or health system-wide charge audit findings to executive staff, board members

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level