Revenue Integrity Analyst II-1

Jefferson Health Plans • Philadelphia, PA

11d • Onsite

About The Position

Works to improve the accuracy, integrity, and quality of patient charges and minimize variation in charging practices. Collaborates with Revenue Cycle and clinical departments to analyze governmental and commercial payer regulations related to authorization, coding, and billing guidelines. Maintains current knowledge of coding guidelines, changing billing regulations, and regulatory agency activities.

Serves as the primary clinical service-line liaison on payer guidelines, regulatory requirements, charge workflows, and revenue-cycle issues. Performs focused charge reviews, analyzes trends and root causes of claim edits or rejections, and recommends workflow improvements and solutions. Reviews Charge Description Master changes, advises service-line leaders on appropriate charge-code use, and supports processes, education, and training to improve charge capture and billing.

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 these credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
• One to three years of experience related to auditing and/or coding is required.
• 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, presentation skills, and customer service skills.
• Ability to research, analyze, and interpret healthcare policies, billing guidelines, and state and federal regulations.
• Ability to document clinical workflows that affect the revenue cycle.
• Excellent organizational and project-management skills.
• Strong time management, attention to detail, and follow-through.
• Motivated individual able to mentor and inspire in a team environment.

Nice To Haves

• Five years of experience in a hospital setting or within the healthcare industry is strongly preferred.
• Applicable professional certification from the American Association of Healthcare Administrative Management (AAHAM) or Healthcare Financial Management Association (HFMA) preferred.

Responsibilities

• Serve as the primary clinical service-line liaison regarding 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 verify charges follow 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 and approve charge additions, deletions, and modifications for accuracy and appropriateness.
• Prepare revenue-cycle meeting materials and facilitate clinical service-line Revenue Cycle department meetings.
• Collaborate with clinical personnel to analyze Charge Description Master billing processes, identify causes of claim issues or rejections, investigate complex issues, and recommend solutions to management.
• Assist with developing and implementing effective chargemaster review, education, and training.
• Interact with co-workers, visitors, and other staff consistent with Jefferson's values.

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, available to all colleagues, including those working less than part-time

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree