Revenue Integrity Analyst

Sanford Health

4d•$23 - $36

About The Position

The Revenue Integrity Analyst is responsible for reviewing and resolving missed or miscoded charges and ensures coding and billing practices are in compliance with coding policies/guidelines related to Medicare/Medicaid and other payer requirements.

Requirements

Associates degree required; Bachelor’s degree preferred. In lieu of education, will consider a minimum of five years’ experience in coding and/or billing.
Experience using Microsoft Office applications such as Outlook, Excel, Word, and Power Point.
A minimum of one of the following credentials required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), Certified Professional Biller (CPB), or Certified Medical Reimbursement Specialist (CMRS). May consider credentials of other relevant disciplines.

Nice To Haves

Epic implementation experience or experience with migration conversions (i.e. Cerner to Epic), Hospital and Clinic Coding and Health Information Management is preferred.

Responsibilities

Responsible for carrying out charge capture initiatives and processes to improve revenue management and integrity.
Ability to use data and reports and perform root cause analysis to identify areas where processes may not be working effectively or efficiently.
Performs trend analysis for missed charges and provides feedback for optimized workflow and problem resolution.
Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies, timeframes and regulatory guidelines.
Develops action plans for clinical departments, as appropriate, to address issues found through charge reviews.
Conducts follow up reviews to ensure correction of identified issues.
Interacts, communications with and provides training to clinical department directors and staff on charge capture monitoring and regulation changes and updates.
Must exhibit excellent analytical skills and the ability to communicate effectively in both oral and written forms.
Ability to prioritize work and changing demands effectively and efficiently.
Exhibits skill in communicating and presenting information at a level of understanding for the appropriate intended recipients.
Requires excellent knowledge of International Classification of Diseases, Tenth Revision (ICD10), Current Procedural Terminology (CPT)/Healthcare Common Procedure coding System (HCPCS) and revenue codes, Centers for Medicare and Medicaid Services (CMS) billing regulations and healthcare reimbursement.
Maintains in-depth knowledge of Medicare and Medicaid coding/billing practices, guidelines, laws and regulations to ensure accurate coding and billing.
Stays current with yearly code updates and changes in billing rules and healthcare reimbursement.