Senior Revenue Integrity Analyst

Children's National Hospital•Pittsburgh, PA

7d•$77,584 - $129,293•Onsite

About The Position

The Senior Revenue Integrity Analyst will report to the Revenue Integrity Supervisor and demonstrate expertise in charge workflows, billing compliance and charge analysis in the pediatric medical setting. The Senior Revenue Integrity Analyst will review, analyze, charge workflows and pricing model/logic for either technical and/or professional services to support compliant billing practices. The Senior Revenue Integrity Analyst will discover possible system/Charging issues for resolution. Will support Revenue Integrity Supervisor with pricing tools, charge workflow changes and support the testing of charge capture workflows for new locations and service lines. The Sr Revenue Integrity Analyst function will ensure compliance with established charging guidelines, third party reimbursement policies, CMS regulations and accreditation guidelines.

Requirements

Associate's Degree Relevant experience beyond the minimum required work experience may substitute the educational requirement on a 1-to-1 ratio.” (i.e., one year of relevant work experience equals one year of required education). (Required)
4 years Experience in charge capture, coding or charge description master in a hospital environment for hospital and professional services. (Required)
Demonstrates excellent organizational and problem solving skills.
Ability to delegate assignments and follow through on details is essential.
Excellent internal and external customer service skills required.
Must possess ability to be effective and efficient in a fast paced environment, managing multiple competing tasks and priorities.

Nice To Haves

Bachelor's Degree Healthcare related field (Preferred)
COC/CPC Coding Certification (Preferred)

Responsibilities

Validate and approve access to all charge workflows and charge corrections, as directed by the CDM Supervisor.
Provide education and in-service training to departments in collaboration with CDM Supervisor.
Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM.
Process complex CDM requests to ensure that all additions, changes and deletions are consistent with proper charging, billing, coding and pricing practices in a timely manner.
Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments, including review of supplies, lab charges and pharmacy charges.
Analyze data within the CDM and assign accurate CPT/HCPCS and revenue codes to the Charge Master to insure compliance with regulatory guidance, per Billing and Coding industry norms.
Distribute coding and billing regulatory requirements and/or announcements to all applicable departments.
Responsible to make CDM related decisions that require significant analysis and investigation.
Assist with developing and maintaining policies and procedures for the CDM, Pricing Policies and charge capture processes.
Perform all maintenance to the Charge Description and Service Master and the Room and Bed Master Files.
Create and maintain all hospital transaction codes and revenue department codes.
Monitor and report all revenue department's charge volumes and posting lag days.
Research and resolve all charge and service master related code errors that affect the recycle and reject reports.
Assist in performing comprehensive reviews with clinical departments to ensure completeness and accuracy of charge description master.
Take initiative to identify system and/or operational problems and participate in the development of solutions to improve billing functions.
Serve as expert resource for code and processing questions, train and educate coders.
Maintain relationships with, and serve as liaison to department administration, physicians, clinic administration, information services, billing offices, financial offices and other departments.
Participate in team meetings/activities and support the philosophy and goals of the team and department.
Provide individual feedback and goal setting recommendations as directed by the Sr Manager.
Adhere to internal controls and reporting structure.
Remain current with updated coding and billing regulations through yearly continuing education; read all announcements and relevant communications that relate to job duties.
Lead special projects/assignments as directed by the CDM Supervisor.