Revenue Integrity Analyst II-1
About The Position
The Revenue Integrity Analyst works to improve the accuracy, integrity, and quality of patient charges and reduce variation in charging practices. The role collaborates with Revenue Cycle and clinical departments to analyze governmental and commercial payer rules for authorization, coding, and billing, and maintains current knowledge of coding guidance, billing regulations, and regulatory agency activity. As the primary clinical service-line liaison, the analyst explains payer requirements, supports accountability and effective charge workflows, and serves as a revenue-cycle subject matter expert for clinical departments. The position reviews charge activity and Charge Description Master requests, identifies opportunities to prevent claim edits and rejections, advises on charge-code use, and supports education, training, and revenue-cycle meetings.
Requirements
- Bachelor's or associate degree in Health Information Management, Business Administration, Accounting, Management, or Healthcare Administration.
- Must hold and maintain at least one of the following credentials: RHIA, RHIT, CCS, or CPC.
- One to three years of experience related to auditing and/or coding.
- Knowledge of Medicare and Medicaid regulations, including billing, coding, and documentation requirements.
- Understanding of reimbursement systems including IPPS, OPPS, and fee schedules.
- Strong oral and written communication skills.
- Ability to research, analyze, and interpret healthcare policies, billing guidelines, and state and federal regulations.
- Ability to document clinical workflows that affect revenue cycle.
- Strong presentation and customer-service skills.
- Excellent organizational and project-management skills.
- Strong time-management, attention to detail, and follow-through.
- Ability to contribute as a motivated team member who can mentor and inspire others.
Nice To Haves
- Five years of experience in a hospital setting or within the healthcare industry is strongly preferred.
- Applicable professional certifications from the American Association of Healthcare Administrative Management (AAHAM) or the Healthcare Financial Management Association (HFMA) are preferred.
Responsibilities
- Serve as the primary clinical service-line liaison on payer guidelines, regulatory requirements, accountability, and charge workflows.
- Act as a subject matter expert for clinical departments on revenue-cycle issues.
- Identify charge-edit trends related to documentation, coding, or charging and recommend workflow improvements.
- Complete focused charge-review assessments for assigned clinical departments or service lines to ensure charges comply with established policies and timeframes.
- Liaise between Revenue Cycle and clinical department administration on revenue, regulatory, coding, billing, and charge-capture matters.
- Develop processes to modify charge-capture applications to reduce charge-related claim edits and rejections.
- Advise service-line leaders and staff on proper charge-code use and identify opportunities to capture additional revenue in accordance with payer guidelines.
- Review Charge Description Master change requests for accuracy and appropriateness, and approve charge additions, deletions, and modifications.
- Prepare revenue-cycle meeting materials and facilitate clinical service-line Revenue Cycle department meetings.
- Collaborate with clinical department personnel to analyze Charge Description Master billing processes, identify root causes of claims issues or rejections, investigate complex issues, and recommend solutions to management.
- Assist with developing and implementing chargemaster review, education, and training.
Benefits
- Medical insurance, including prescription coverage
- Supplemental insurance
- Dental insurance
- Vision insurance
- Life and AD&D insurance
- Short- and long-term disability
- Flexible spending accounts
- Retirement plans
- Tuition assistance
- Voluntary benefits, including access to group insurance rates and discounts
- Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
- Medical insurance, including prescription coverage, is available to all colleagues, including per diem colleagues, adjunct faculty, and Jeff Temps
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
