Sr. Revenue Integrity Analyst- On-site position

About the position

The on-site Sr. Revenue Integrity Analyst reviews and revises accounts to achieve revenue enhancement and compliance. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing. The incumbent establishes and maintains a library of rule, regulations, policies and procedures of all governmental and commercial payors.

Responsibilities

• Assist various departments in ensuring all denials are captured & appealed in a timely manner. Coordinating appeal discussions with clinical & third party payors.
• Develop, Implement and coordinate billing practices between hospital and physician groups to ensure uniform coding and documentation.
• Recommend sound financial best practices that are able to withstand audits.
• Foster continuous improvement of revenue cycle processes through education with various departments.
• Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered.
• Analyze and maintain WMCHealth Network Hospitals CDM's to maximize revenue.
• Perform periodic review of codes and work with patient billing regarding bundling and unbundling services as delineated in CMS and CCI edits.
• Coordinate and serve as liaison with CDM software companies to evaluate and validate CPT and revenue codes and related coverage issues.
• Engage with various departments to identify opportunities during EMR implementation and provide feedback and recommendations.
• Serve as the finance liaison with ancillary departments regarding CDM service and procedure changes and educate departments regarding the impact of CDM regulatory changes.
• Research technical guidance in UB-92 Editor, CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance.
• Maintain and provide information on status of audits and issues presented.
• Participate in quantifying audit outcomes, including revenue realized.
• Research and communicate appropriate treatment of charges to clinical managers, CDM Specialist (coordinator), other customers.
• Participate in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
• Perform other duties as assigned.

Requirements

• Minimum 8 plus years clinical experience in a hospital setting, preferably cardiology, radiology, surgery or utilization review, required.
• Previous revenue integrity experience, Excel and Electronic Medical Records experience preferred.

Nice-to-haves

• Graduate of an accredited program (RN,MD,PA), degree in healthcare preferred.
• Bachelor's degree or equivalent work experience (8 plus years) required.
• Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H), preferred.
• Familiarity with medical record documentation standards and practices, health care insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and ICD-9-CM codes is preferred.

Benefits

• Requires travel to other WMCHealth Facilities.