Revenue Integrity Analyst

SouthEast Alaska Regional Health Consortium•Juneau, AK

About The Position

The Revenue Integrity Analyst is responsible for improving charge capture, reimbursement, and revenue-cycle quality through support and management of revenue-cycle applications, process automation, Charge Description Master (CDM) management, claims, analysis and reporting, clinical and departmental integration, and compliance, contract-payment, and denials auditing. The role works with clinical, operational, and supporting departments to develop integrated design solutions and uses data and workflow analysis to identify and resolve system, user, and process issues. It also serves as an internal resource across revenue-cycle topics and provides education and guidance to patient revenue-generating departments and providers. SEARHC is a nonprofit health consortium serving the health interests of Southeast Alaska residents. The organization describes employees as its strongest assets and supports their professional development and advancement.

Requirements

Bachelor's degree or an 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 a Revenue Cycle, Finance, or Clinical capacity.
Knowledge of end-user workflows, including scheduling, registration, clinical, ancillary, 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, procedures, participation, 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, and Electronic Health Record applications.
Ability to manage multiple projects and overlapping commitments and deadlines in a fast-paced environment.
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 another professional certification or licensure.

Responsibilities

Optimize and troubleshoot revenue-cycle applications.
Collaborate with clinical, operational, and supporting departments and other stakeholders to develop integrated design solutions.
Analyze available data to support Revenue Cycle team initiatives, including identification, definition, resolution planning, and implementation for system and user deviations, inconsistencies, and process failures.
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 issues, workflow issues, and training gaps.
Perform quality assurance and validation tasks.
Provide education and guidance to patient revenue-generating departments and providers to support appropriate charge capture.