RN Revenue Integrity Analyst

Mercyhealth•Janesville, WI

6d•Onsite

About The Position

Seeking an experienced Revenue Integrity professional to partner with clinical leaders and ensure accurate charge capture, coding, and billing practices across service lines. This role evaluates charging processes, identifies revenue opportunities, monitors EPIC Revenue Integrity dashboards, supports compliance with payer and regulatory requirements, and provides education and guidance to clinical teams. The ideal candidate has strong analytical and communication skills, healthcare revenue cycle knowledge, and the ability to manage moderately complex revenue integrity projects.

Requirements

Bachelor of Science in Nursing degree and +three (3) years of experience within the revenue cycle.
Licensed as an RN in state of practice.
Approved CPR or BLS certification required within 90 days.

Nice To Haves

Experience above minimum requirement will be considered in lieu of education.
In excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; hospital leadership.
Clinical leadership experience preferred with high level focus charges/revenue.
EPIC HB/PB experience preferred.
Knowledge of CPT/HCPCS procedural coding preferred.
Other certification per unit requirements: ACLS, PALS, PEARS, NRP.

Responsibilities

Interacts with clinical department directors to monitor charge capture functions across all entities.
Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities.
Monitors EPIC Revenue Integrity Dashboard(s).
Participates in moderately complex projects related to revenue integrity initiatives.
Provide support for assigned cost centers within service lines.
Participates in analyzing changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
Train and assist clinical team with revenue integrity functions.
Performs miscellaneous duties as assigned.