Sr. Data Integrity Analyst

OrthoVirginia•Richmond, VA

About The Position

At OrthoVirginia, you’re part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia’s largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment. With more than 159 physicians in over 35 locations—including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads—OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive. Join us and become part of a trusted network committed to excellence in orthopedic care. Reporting and Analysis: Analyze key performance indicators (KPI’s) revenue cycle metrics identifying trends, creating and maintaining reports and dashboards for leadership and performing root cause analysis on revenue cycle issues. Ensure the prevention of payment denials and claim resolution by investigating and correcting claim edits, denials, holds and system edits and billing rules set up. Charge Master Management (CDM): Overseeing charge master accuracy, testing updates and integrating new services. Updates CPT, HCPCS and revenue codes to ensure accurate pricing and billing transparency. Determine appropriate methods to analyze operations, relevant information, and data. Create new queries and analysis tools, develop databases as needed and acquire desired data. Interprets results, identifies trends, and provides director with business insights and performance metrics using data analysis methods and modeling. Education, Compliance & Auditing: Provide training and resources to clinical and billing staff on proper charging and documentation practices. Performs analysis on an ad hoc basis as required to support the operational needs of the Patient Accounts Department. Able to communicate effectively (written and verbal) the findings of analyses and audits to support operation and financial decisions. Acts a local support and super user in systems including EMR, clearinghouse and variance denials tools, working with all levels of associates to identify issues and root causes and make recommendations for process improvements. Provide project management support for leadership. Leads implementation plans to ensure stability of workflows and solutions. Lead the implementation and management of automation reports, dashboards, and other SQL-based analytics tools used for revenue cycle and other critical business functions. Create and manage documentation (such as SOPs and data dictionaries) for various data solutions, reports, and dashboards. Teamwork: Works cooperatively with coworkers, providers, and management. Shares knowledge and insights with co-workers in a constructive manner. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision. Addresses conflicts with person directly before involving manager or uninvolved peers.Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department. Policies and Procedures: Knows and complies with policies and procedures as enumerated in the company employee handbook and policies and procedures documents. Provides assistance and support to leadership in implementing policies and procedures as necessary. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs. Education, Experience, and Certification/Licensure Required: A bachelor’s or associate degree in Healthcare Administration, Finance, Health Information Systems, Statistics, or a related field is required. A minimum of five years of professional experience, preferably in a healthcare setting, is required. Experience should include working with large datasets, developing complex queries and analyses, managing multiple projects, and preparing reports and presentations within a multidisciplinary team environment for leadership. This role requires a strong understanding of medical terminology, human anatomy, ICD10/CPT coding, and medical insurance reimbursement models. Candidates must demonstrate proficiency with Microsoft Office applications, including Excel, Word, Teams, and PowerPoint. SQL and Epic EMR experience are required. Excellent communication, analytical thinking, facilitation, problem solving, and project leadership skills are essential. This organization participates in e-Verify. Esta organización participa en e-Verify. With more than 150 orthopedic specialists in over 35 locations in Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads, OrthoVirginia is Virginia’s largest provider of orthopedic medicine and one of the leading providers of physical, hand and occupational therapy. As one of the largest orthopedic specialty practices in the country, OrthoVirginia’s nationally recognized physicians provide advanced surgical and non-surgical care to patients of all ages. Introduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match.

Requirements

A bachelor’s or associate degree in Healthcare Administration, Finance, Health Information Systems, Statistics, or a related field is required.
A minimum of five years of professional experience, preferably in a healthcare setting, is required.
Experience should include working with large datasets, developing complex queries and analyses, managing multiple projects, and preparing reports and presentations within a multidisciplinary team environment for leadership.
This role requires a strong understanding of medical terminology, human anatomy, ICD10/CPT coding, and medical insurance reimbursement models.
Candidates must demonstrate proficiency with Microsoft Office applications, including Excel, Word, Teams, and PowerPoint.
SQL and Epic EMR experience are required.
Excellent communication, analytical thinking, facilitation, problem solving, and project leadership skills are essential.

Responsibilities

Analyze key performance indicators (KPI’s) revenue cycle metrics identifying trends, creating and maintaining reports and dashboards for leadership and performing root cause analysis on revenue cycle issues.
Ensure the prevention of payment denials and claim resolution by investigating and correcting claim edits, denials, holds and system edits and billing rules set up.
Overseeing charge master accuracy, testing updates and integrating new services.
Updates CPT, HCPCS and revenue codes to ensure accurate pricing and billing transparency.
Determine appropriate methods to analyze operations, relevant information, and data.
Create new queries and analysis tools, develop databases as needed and acquire desired data.
Interprets results, identifies trends, and provides director with business insights and performance metrics using data analysis methods and modeling.
Provide training and resources to clinical and billing staff on proper charging and documentation practices.
Performs analysis on an ad hoc basis as required to support the operational needs of the Patient Accounts Department.
Able to communicate effectively (written and verbal) the findings of analyses and audits to support operation and financial decisions.
Acts a local support and super user in systems including EMR, clearinghouse and variance denials tools, working with all levels of associates to identify issues and root causes and make recommendations for process improvements.
Provide project management support for leadership.
Leads implementation plans to ensure stability of workflows and solutions.
Lead the implementation and management of automation reports, dashboards, and other SQL-based analytics tools used for revenue cycle and other critical business functions.
Create and manage documentation (such as SOPs and data dictionaries) for various data solutions, reports, and dashboards.
Works cooperatively with coworkers, providers, and management.
Shares knowledge and insights with co-workers in a constructive manner.
Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
Addresses conflicts with person directly before involving manager or uninvolved peers.
Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.
Knows and complies with policies and procedures as enumerated in the company employee handbook and policies and procedures documents.
Provides assistance and support to leadership in implementing policies and procedures as necessary.
Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.