Revenue Integrity Analyst

Prime Healthcare • Riverdale, GA

22h

About The Position

Prime Healthcare is an award-winning health system headquartered in Ontario, California, operating 54 hospitals and over 360 outpatient locations in 15 states, providing more than 3.0 million patient visits annually. With over 60,000 employees and physicians, it is one of the nation’s leading health systems. The Revenue Integrity Analyst is responsible for determining the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding. This involves reviewing and analyzing medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices. The role includes verifying coding, charging, and billing data for accuracy, completeness, and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of claims. The analyst will coordinate to ensure optimum process towards maintaining a low DNFB by clarifying any process failures, such as clinical documentation deficiencies or late charge entry IT related technical issues. This position also serves as a liaison between facility administration, patient accounts, and ancillary department directors regarding charging issues, clinical documentation issues, and revenue opportunities. Key responsibilities also include providing review results and developing and coordinating educational in-services for facility staff related to charging/billing issues. At times, this position may collaborate with the Compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.

Requirements

• Bachelor's degree in Healthcare, Business, or related field (Combination of education and experience is also acceptable).
• Two years’ experience in a role related to revenue capture/charging, auditing, coding.
• Strong quantitative, analytical and organization skills.
• Proficient in chart review, clinical record information systems and coding methodologies.
• Ability to understand and interpret medical records, hospital bills, and the Charge Master.
• Ability to understand all ancillary department functions.
• Excellent written and verbal communication skills.
• Excellent critical thinking skills.
• Ability to work independently in a time-oriented environment.

Nice To Haves

• Epic proficiency in Hospital Billing.
• Use of an encoder software product for code assignment in an acute care setting.
• Working knowledge of Medicare & Medicaid reimbursement system and coding structures.

Responsibilities

• Determine the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding.
• Review and analyze the medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices.
• Verify coding, charging and billing data for accuracy and completeness and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, claims scrubber systems, or in the payer’s system.
• Coordinate to ensure optimum process towards maintaining a low DNFB by clarifying any process failures, i.e., clinical documentation deficiencies, late charge entry IT related technical issues, etc.
• Serve as a liaison between facility administration, patient accounts and ancillary department directors, regarding charging issues, clinical documentation issues and revenue opportunities.
• Provide review results and develop and coordinate educational in-services for facility staff related to charging/billing issues.
• Collaborate with the Compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits (at times).

What This Job Offers

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