Revenue Integrity Analyst

Shriners Children's

2d • Remote

About The Position

The Revenue Integrity Analyst ensures that all items and services such as procedures, patient visits, supplies, and pharmaceuticals that are charged through the Charge Description Master (“CDM”) are described, coded, and priced appropriately and are representative of services provided. Educates ancillary departmental and clinical staff on required changes needed to address regulatory changes and payor changes and works with them to implement necessary changes.

Requirements

• 1-3 years of experience performing CDM related activities
• Experience with CPT-based coding principles from both an inpatient and outpatient reimbursementperspective
• Experience with UB-04, MA claim form, and the HCFA-1500, charge development process and the interrelationship of costaccounting, cost management, and related functions, charging processes and compliance issues
• Associate's Degree in business/accounting/finance or healthcare business administration - or combination education and experience considered in lieu of degree
• Epic EMR required

Nice To Haves

• Applicable clinical or professional certification and licenses desirable
• Experience working with Craneware

Responsibilities

• Conduct charge capture assessment activities including, interviews, research and outcomes analysis. Provides analysis, well-supported documentation and recommendations for changes, additions and/or corrections to the CDM according to best practice and company standards
• Maintain continuous communication with the revenue departments and provides Revenue Integrity management with information relating to operational opportunities. Collaborate with department managers and staff to review documentation supporting charge capture. Identify areas of deficiency and work with department managers to develop process improvement programs to support compliant billing
• At the request of clinical department managers, attend staff meetings to present identified problems and solutions related to charge capture and reconciliation
• Support new service addition request process
• Assist in defining and assures compliance with the requirements for standardized charge capture workflows. Assist with the monitoring of the SHC Corporate system – wide CDM to ensure that the coding of new and existing charge codes is within applicable coding and billing guidelines
• Perform technical review to ensure accuracy, validity, appropriateness, and completeness of CDM
• Research CDM and patient charge issues and inquiries
• Document and implement a periodic review schedule in conjunction with the charge integrity analysts to confirm that the CDM accurately reflects all services being rendered
• Document all changes and/or revisions to CDM by using appropriate software programs
• Participate in the implementation and audit processes to ensure that charges are applied uniformly to all patient services at a physical location, regardless of payer. Performs audits with a focus on revenue cycle integrity, assist in the development and implementation of charge practices
• Work with Revenue Integrity leadership and department/clinical managers to develop ongoing education programs on charge capture, entry process, reconciliation, rejections, and other charge related processes for departmental leaders and staff members.
• Assist in developing and executing educational programs, training literature, in-services, and workshops under the direction of the department managers. Confirm that education programs are implemented, and all participants successfully pass the programs
• Serve as the primary operational point of contact for Revenue Integrity with other departments regarding charge transactions
• Develop and maintain current database of industry-wide data to be used in benchmarking exercises and make information available to all staff
• Assess the accuracy of charging vehicles. Works with IS to determine updates required in the software system to ensure appropriate and compliant charges
• Test all implemented changes through bill from generation to confirm that bill forms accurately reflect the services being rendered and comply with regulatory and payor requirements
• Assist in identifying, defining and functioning within SHC proprietary software processes; review and/or development of reports and audit tools to support the requirements for revenue integrity and outcomes measurement
• Compile statistically related data, construct reports and trend information of late entry, missing, inappropriate, or other matters related to charges
• Effectively and professionally communicates results, challenges and solutions through daily interaction, regular reports and monthly status meetings with Manager of Revenue Integrity Analysts
• Develop and deliver organized, concise yet thorough reporting and communications to management, Sr. Leadership, and other departments regarding proposed, deficiencies, developments and opportunities affecting the Organization regarding charge capture
• Assists the department, work unit and/or fellow staff members by covering for absences, training activities, etc.
• Participate in departmental projects and offers input for the continuous improvement of organizational practices
• Prioritizes and manages multiple tasks simultaneously to effectively anticipate and respond to issues as needed in a dynamic work environment
• Perform other work-related duties as assigned or requested

Benefits

• All employees are eligible for medical coverage on their first day!
• In addition, upon hire all employees are eligible for a 403(b) and Roth 403(b) Retirement Saving Plan with matching contributions of up to 6% after one year of service.
• Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected.
• Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more!
• Coverage is available to employees and their qualified dependents in accordance with the plans.

What This Job Offers

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