Revenue Integrity Analyst

Gundersen Health System • Stanfold, WI

1d • Hybrid

About The Position

Love + medicine is who we are, it's what we do, it's why people want to work here. If you’re looking for a job to love, apply today. Scheduled Weekly Hours: 40 Emplify Health is looking to hire three Revenue Integrity Analysts to join our team! Responsible for identifying opportunities or problems, process improvements and other system changes to enhance revenue cycle performance. This role will have ongoing interactions with clinical leadership, revenue cycle staff, Finance, and IT teams. The analyst works closely with revenue cycle departments to ensure that clinical departments are informed regarding regulatory changes that affect charging processes. This position is essential in collaborating with clinical areas on charge reconciliation. Must demonstrate in-depth knowledge of CPT, HCPCS, ICD-10, as well as the current local payer policies for coding, billing, and claims processing.

Requirements

• Minimum 4 years in healthcare plus experience with clinic/hospital billing systems
• Certification from a recognized professional coding or health information organization, such as AAPC or AHIMA.
• Analytical Thinking: Ability to interpret complex data and provide actionable insights.
• Communication: Strong verbal and written communication skills; comfortable presenting to executive leadership.
• Adaptability: Thrives in a dynamic environment with evolving regulations and priorities.
• Problem-Solving: Proactively identifies issues and develops innovative solutions.
• Attention to Detail: Ensures accuracy in charge capture, compliance, and financial reporting.

Nice To Haves

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field preferred; equivalent relevant experience may be considered in lieu of degree.

Responsibilities

• Researches and analyzes both professional (PB) and Facility (HB) claims prior to new clinical services being added to ensure the appropriate reimbursement of claims. This includes all payors; to see that government regulated billing rules and payer policies are being reinforced.
• Collaborates with Clinical Operation Directors and Clinical leaders to perform charge reconciliation to ensure performed visits, procedures, and tests are appropriately billed.
• Collaborates with Clinical Operation Directors and Clinical leaders to create mitigation plans for charges that are not entered in a timely fashion to ensure we are not at risk for revenue loss.
• Interprets existing revenue cycle policies and operating practices to make recommendations for improvement.
• Demonstrates in depth knowledge and technical expertise in CPT, HCPCS, ICD-10, as well as current payer policies for coding, billing and claims processing, and provider-based billing rules.
• Serves as the point of contact for complicated billing scenarios to establish proper process(es) to get the claim filed.
• Facilitate multi-department billing steering committee.
• Oversees and helps maintain the Revenue Guardian Edits in Epic.
• Reviews Epic Dashboards to ensure all charges are captured in a timely manner, are in compliance with state and Federal guidelines and are achieved within expected window after patient discharge.
• Identifies and works with Information Systems to rectify any claims data transmissions issues as they arise and track any changes.
• Creates, generates, and maintains ad hoc reports proactively and as requested on various transactions to ensure consistency on claims submissions and to direct chargemaster analyst as needed to update clinical charge capture in Epic.
• Maintains extensive knowledge of current EHR technical and professional billing software modules and how it relates to all payer processes.
• Collaborates closely with all Revenue Cycle leaders on processes, procedures, and defining improved workflows for billing and reimbursement practices and appropriate claims submission.
• Collaborates with Compliance on governmental regulated billing rules and policies to ensure new services are set up appropriately.

Benefits

• In addition to medical and dental, we have pet insurance and a substantial contribution to retirement
• 24/7 Employee Assistance Program for employees and their families, generous PTO and paid holidays
• Tuition Invest Program totaling up to $3k per year, access to a catalogue of hundreds of internal courses, corporate incubator, Career Development Center

What This Job Offers

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