Revenue Integriy Analyst, Physician Billing

Erlanger Health System•Chattanooga, TN

38d

About The Position

The Revenue Integrity Analyst plays a pivotal role in ensuring financial health for the professional services team by meticulously managing the charge master, regulation code changes, work queues, charge capture, charge reconciliation, reporting, and analytical trending. This includes the identification of root cause and creation/maintenance of processes to ensure charge capture. In addition, this position is required to provide analytical insight regarding reports for charges that are not captured accurately or consistently. This position is responsible for uncovering root causes and developing a correct action plan. Recommends modifications to established practices and procedures or system functionality as needed to support Revenue Cycle and then manages implementation of those recommended changes.

Requirements

Collaboration - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success.
Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed.
Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently.
Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required; is proactive and pursues relentlessly.
Adopts a philosophy consistent with Erlanger Health's Mission, Vision, and Values, and models these standards.
Strong interpersonal skills facilitate seamless communication with the clinical staff, and faculty.
Solid understanding of coding conventions and current third-party payer rules and regulations.
Current knowledge of third-party payer rules and regulations.
Knowledge of management and supervision and the ability to organize staff's work.
Knowledge and understanding of computers to confidently monitor and obtain information from electronic medical records and database system.
Ability to work independently and demonstrate problem-solving skills.
Ability to apply critical thinking skills to complex issues and situations.
Knowledge and understanding of the requirements for complete medical records per Erlanger Health Bylaws, rules and regulations, DNV, Federal, State, and regulatory body regulations.
Demonstrates command of written and telephone communication skills.
Ability to maintain confidentiality and adhere to federal, state, HIPAA, and hospital policy in regards to privacy of patient health information.
Organizational skills to effectively demonstrate ability to prioritize during job performance.
Knowledge of windows operating system, Microsoft Office products, Electronic Health Record System, Document Imaging System and office equipment.
High school graduate or equivalent.
CPI Annual/Biannual training if applicable.
Must have working-level knowledge of the English language, including reading, writing, and speaking English.
3-5 years related experience required with extensive knowledge of ICD-10-CM and CPT coding principles.
Good organizational, written, and verbal communication skills.
Certified Professional Coder (CPC), or Certified Outpatient Coder (COC), or Certified Coding Specialist, or Registered Health Information Technician (RHIT), or Registered Health Information Administrator.

Nice To Haves

Associates or Bachelor's Degree in Business Administration, Finance, or related field
Certified Revenue Cycle Specialist, RCMS, or CHRI, or CRCS

Responsibilities

Charge Master
Evaluates current charging processes to diagnose the root cause of any charge inefficiencies and ensures standard charge practices are implemented.
Analyzes changes to coding and billing rules and regulations and using independent decision making to ensure appropriate updates to CDM and charge processes are implemented.
Prepare and present quarterly and annual CPT/HCPCS changes, annual pricing updates and provide education material and presentation.
Conduct thorough research to ensure the Charge Description Master (CDM) is maintained regularly.
Leads efforts of collaboration with multi-disciplinary groups responsible for monitoring and assuring the accuracy and enhancement of the charge master.
Operational Improvement
Collaborates with stakeholders in revenue enhancement projects as needed.
Provides leadership and expertise with various groups to develop new areas of review for future revenue enhancement and/or compliance initiatives.
Conduct thorough analysis of billing errors and denial data to diagnose root causes. Utilizes independent decision making to execute work plans to correct identified deficiencies related to charge problems. Responsible for problem solving and resolution of complex claim edits.
Stay up to date with industry trends, emerging technologies, and regulatory changes affecting healthcare revenue cycle management and proactively share knowledge with the team.
Perform Quality Assurance on team members, as needed.
Trending and analysis of key data to identify areas for additional education.
Charge Capture
Serves as subject matter expert (SME) of charge capture methodologies and helps investigate and solve charging issues and provide charge capture recommendations to clinical departments and hospital staff.
Diagnoses root cause issues of charge problems and provide education for best practice recommendations for improvement.
Conduct root cause analysis on late charge reporting and provide education for timely charge capture.
Ensure effective monitoring and internal control processes in place to improve revenue capture.
Identify operational performance and revenue opportunities through detailed data review.
Ensure effective monitoring and reporting control processes in place to improve performance.
Coordinate operational objectives by contributing information and recommendations to strategic plans and reviews; preparing and completing action plans.