Revenue Integrity Senior Analyst - HMFP

Beth Israel Lahey Health•Boston, MA

57d

About The Position

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the direction of the Director, Revenue Integrity and Coding at Harvard Medical Faculty Physicians (HMFP) at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, which aims to maximize synergies across HMFP departments, initiate and lead revenue integrity and coding process improvement, identify and address risks, monitor key revenue integrity and coding operational and financial metrics, provide subject-matter expertise, and ensure adherence to established standards and policies. Job Description: Primary Responsibilities • Monitor departments’ adherence to professional charge reconciliation, work-queue, and professional coding quality expectations and support departments with education, process improvement, and follow-up. • Conduct periodic departmental reviews of professional charge reconciliation processes to ensure adherence to policies and confirm all professional charges are captured and reported accurately • Review and document changes within the charge description master (CDM) and fee schedule(s) and ensure these changes are implemented within appropriate systems. Route for approval according to HMFP’s established policies and procedures. • Lead annual, quarterly, and regular CDM and fee schedule maintenance activities. • Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement. • Support departments with analyzing services for coverage and reimbursement. • Work with HMFP departments to identify revenue management opportunities, staying current with government and commercial payer’s billing and coding requirements. • Develop, deliver, and revise revenue integrity and coding education and training programs in coordination with the Director and HMFP Compliance Department. • Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate stakeholders and provide any necessary follow-up. • Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly. • Monitor coder quality audit results and coder productivity. Support departments by establishing audit processes, education and training, process improvement, and follow-up. • Lead assigned revenue integrity and coding projects, committees, and meetings. • Develop and execute tools and processes to identify potential areas of delayed or lost revenue. Collaborate with departments on process improvement and necessary follow-up. • Build strong relationships and facilitate effective communication between key stakeholders. Collaborate with others to develop and implement action plans to resolve revenue integrity and coding issues. • Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken for the Director and other stakeholders.

Requirements

Bachelor’s degree required.
Certification: Certified Professional Coder (CPC) required.
5 or more years physician/professional revenue operations experience with a focus in one or more of the following areas: coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, CDM management.
Extensive knowledge of: o revenue cycle processes and physician billing o code sets to include Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS), and International Classification of Diseases (ICD-10) o reimbursement theories to include RBRVUS, MPFS, and managed care o NCCI edits and Medicare LCD/NCDs o health care documentation, coding and billing requirements as well as federal and state health care regulatory requirements o health care compliance o medical terminology, anatomy and physiology along with clinical department activities.
Abilities: o Manage large complex projects assignments, investigate, analyze and resolve issues at a high level. o Excellent communication, presentation, organizational, analytical and problem-solving skills. Must communicate effectively with physicians, leadership, and other billing personnel. o Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment. o Advanced skills with Microsoft Office, including Outlook, Word, Excel, PowerPoint, Power BI and other web-based applications. Ability to produce complex documents. o Strong analytical ability. Skills to collect, organize and analyze data, produce actionable reports, and recommend improvements and solutions.

Nice To Haves

EPIC PB experience preferred.

Responsibilities

Monitor departments’ adherence to professional charge reconciliation, work-queue, and professional coding quality expectations and support departments with education, process improvement, and follow-up.
Conduct periodic departmental reviews of professional charge reconciliation processes to ensure adherence to policies and confirm all professional charges are captured and reported accurately
Review and document changes within the charge description master (CDM) and fee schedule(s) and ensure these changes are implemented within appropriate systems. Route for approval according to HMFP’s established policies and procedures.
Lead annual, quarterly, and regular CDM and fee schedule maintenance activities.
Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement.
Support departments with analyzing services for coverage and reimbursement.
Work with HMFP departments to identify revenue management opportunities, staying current with government and commercial payer’s billing and coding requirements.
Develop, deliver, and revise revenue integrity and coding education and training programs in coordination with the Director and HMFP Compliance Department.
Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate stakeholders and provide any necessary follow-up.
Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly.
Monitor coder quality audit results and coder productivity. Support departments by establishing audit processes, education and training, process improvement, and follow-up.
Lead assigned revenue integrity and coding projects, committees, and meetings.
Develop and execute tools and processes to identify potential areas of delayed or lost revenue. Collaborate with departments on process improvement and necessary follow-up.
Build strong relationships and facilitate effective communication between key stakeholders. Collaborate with others to develop and implement action plans to resolve revenue integrity and coding issues.
Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken for the Director and other stakeholders.