Revenue Integrity Analyst - Concord, CA (On-Site)

Planned Parenthood Northern California (PPNorCal) is seeking a Revenue Integrity Analyst for our Concord Administration Office in Todos Santos Plaza. This role is full-time, 40 hours per week. PPNorCal provides a comprehensive benefits package including 100% employer paid medical insurance for the employee, 50% employer paid medical insurance for dependent children, dental and vision coverage, employer paid life and long-term disability insurance, 15 days of paid time off to start, 10 paid holidays, and a 403(b) retirement plan with up to 4% employer match after 12 months of service.

Job Summary:

The Revenue Integrity Analyst plays a vital role in optimizing the financial performance of the healthcare organization by analyzing and improving revenue cycle processes. This individual is responsible for identifying opportunities for revenue enhancement, streamlining workflows, and ensuring compliance with billing and reimbursement regulations.

Key Responsibilities:

• Data Analysis and Reporting:

• Collect and analyze data related to the revenue cycle, including patient billing, claims processing, payment collections, and denials.

• Generate detailed reports on revenue cycle metrics, such as days in accounts receivable (A/R), denial rates, and cash collections.

• Present findings and recommendations to management to inform strategic decisions.

• Revenue Cycle Optimization:

• Identify bottlenecks and inefficiencies in the revenue cycle process.

• Develop and implement process improvements to enhance revenue cycle performance.

• Collaborate with various departments (e.g., billing, coding, patient registration) to ensure seamless operations.

• Denial Management:

• Analyze denial trends and identify root causes.

• Develop strategies to reduce denial rates and improve first-pass resolution rates.

• Work with coding and billing teams to address and resolve denied claims.

• Compliance and Regulatory Adherence:

• Ensure all revenue cycle activities comply with federal, state, and local regulations, including HIPAA and Medicare/Medicaid guidelines.

• Stay updated on changes in healthcare regulations and adjust processes accordingly.

• Technology Utilization:

• Utilize revenue cycle management software and tools to streamline processes.

• Implement and maintain EPIC electronic health records (EHR) and practice management systems.

• Provide training and support to staff on revenue cycle-related technologies.

• Financial Analysis:

• Conduct financial analysis to identify trends and areas for improvement.

• Perform Proposition 56 Supplemental Rate payment reconciliation and collections activities to include: calculation of amounts owed to PPNorCal, claim level reconciliation of amounts owed to actual payments received, communication with payers regarding Prop 56 claim data amounts outstanding, and ongoing reporting to Finance management regarding collection status.

• Monitor key performance indicators (KPIs) and adjust strategies to meet financial goals.

• Customer Service:

• Address patient billing inquiries and resolve issues promptly and professionally.

• Work with insurance companies to facilitate claim processing and payment resolution.

• Ensure a positive patient experience by maintaining clear communication and efficient service.

• Other Duties and Responsibilities:

• Other duties and special projects as assigned.

• Actively participate in the advancement of PPNorCal Diversity, Equity, and Inclusion commitment.

QUALIFICATIONS:

• Education:

• Bachelor's degree in finance, healthcare administration, business, or a related field preferred or equivalent combination of education and work related experience in revenue cycle billing and finance.

• Certified Professional Coder (CPC), Certified Revenue Cycle Specialist (CRCS), Certified Revenue Cycle Professional (CRCP), or similar certification preferred.

• Experience:

• Minimum of 3-5 years of experience in revenue cycle management or healthcare finance.

• Experience with healthcare revenue cycle software, such as Epic, Cerner, or NextGen.

• Advanced proficiency in Microsoft Excel or other data analysis software.

• Proven track record of analyzing and improving revenue cycle processes.

• Skills:

• Strong analytical and problem-solving skills.

• Proficiency in revenue cycle management software and EPIC EHR systems.

• Excellent communication and interpersonal skills.

• Detail-oriented with the ability to manage multiple tasks and deadlines.

• Knowledge:

• In-depth understanding of healthcare billing and coding practices.

• Familiarity with healthcare regulations and compliance requirements.

• Knowledge of financial analysis and reporting techniques.

LANGUAGE SKILLS

Ability to read, write and comprehend simple instructions, short correspondence, and memos. Ability to effectively present information in one-on-one and small group situations to customers, patients, and other employees of the organization.

MATHEMATICAL SKILLS

Strong mathematical skills required. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY

Strong ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

COMPUTER SKILLS

Advanced knowledge of Microsoft Office Suite Outlook, Word and Excel. Knowledge of Electronic Health Records/Electronic Practice Management systems, EPIC experienced strongly preferred.

PROTECTED HEALTH INFORMATION (PHI) ACCESS REQUIREMENT

As required for patient billing requirements.

CERTIFICATES, LICENSES, REGISTRATIONS

Certified Professional Coder (CPC), Certified Revenue Cycle Specialist (CRCS), Certified Revenue Cycle Professional (CRCP), or similar certification preferred.

Pay Range: Planned Parenthood Northern California (PPNorCal) supports California's new law (SB 1162) enhancing pay transparency. This new law requires employers with 15 or more employees to include a pay range in job postings. The pay range reflects the compensation that a new employee can expect to receive if offered employment. Employees with more experience, education, and other qualifying factors may be compensated at a higher rate of pay. The pay range for this position is: $75,000.00-$82,500.00 Annualized salary.

Planned Parenthood Northern California is an equal opportunity employer and works affirmatively to include diversity among its staff and does not discriminate on the basis of race, color, ethnicity, religion, sex/gender identity, sexual orientation, national origin, age, disability, income, marital status, or any other irrelevant dimension of diversity. PPNorCal values collaboration between employees of diverse backgrounds and experiences.

We provide healthcare and education services to 137,000 adults and youth every year at 17 health centers located throughout 20 Northern California counties. Planned Parenthood Northern California offers high-quality, affordable health care to all, regardless of income, insurance, or immigration status. We care. No matter what! Our experienced and caring medical staff gives each patient honest information and personal attention. We provide a full range of services, including birth control, breast exams, cancer screenings, medication and in-clinic abortion, pregnancy testing and counseling, prenatal care, PrEP, and nPEP to prevent HIV infection, STD screening and treatment, vasectomy and infertility services, gender-affirming hormone therapy, and more.