Revenue Integrity Analyst R32993

Req#: R32993

Category(s): Finance, Revenue Cycle

Full Time / Part Time: Full-Time

Shift: First

Summary Description:

The Revenue Integrity Analyst will report the the Director, Revenue Integrity and Advisory Services. They will ensures consistent charge capture and billing to promote optimal reimbursement by applying appropriate management of the Charge Error Worklist (CEWL), Correct Code Initiative (CCI) edits and Soarian billing edits in a timely fashion, coordinating efforts with other areas in the revenue cycle and clinical areas and reports and analyzes the impact of denials and coding changes. In addition this position is responsible for support and implementation of all changes to the Charge Description Master (CDM) for the Baystate Health hospitals and Baystate Medical Practice. The incumbent performs analytical review of the charge description master and submitted changes from departments to ensure proper pricing and assignment of billing codes. S/he serves in the role of system administrator for the CDM application, responsible for testing and user access. S/he participates in initiatives related to hospital billing, advising on charge capture workflows.

Job Responsibilities:

1. Ensure that all requested additions, deletions and modifications to the CDM are properly processed in a timely manner.

2. Serve as the system administrator for CDM software, coordinating maintenance of the software, interfacing to the patient financial system and user access

3. Investigate and correct problems with the charging process. Provide a high level of support to other departments in the revenue cycle.

4. Obtain and apply knowledge in the following Revenue Cycle Business Functions: Charge Capture, Coding, Billing, Denial Management (including the associated IT systems) to support revenue cycle initiatives.

5. Monitor and report on the financial results by collecting, analyzing, interpreting, and reporting key revenue management data, including conducting weekly and monthly variance reports. Possess the technical skills needed to compile and manage data from numerous disparate information systems.

6. Represent the department on projects and system implementations related to revenue cycle and provide valuable input to ensure success.

7. Perform other duties as requested by management. Provide support to new projects that arise.

• Reviews Correct Coding Initiatives (CCI) and Soarian edits for trending analysis and charge capture opportunities

• Analyzes correlation between coding edits and departmental monthly charge reports

• Provides assistance on special projects as assigned

• Participates on training and educational initiatives regarding clinical documentation to support charge optimization

• Provide resolutions for charging process and compliance issues by performing internet research, utilizing third party

payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines.

• Develop, prepare and analyze statistical reports
• S/he monitors billing reports for compliance with CMS regulations and communicates findings and recommendations. S/he will have experience with CPT and HCPCS coding guidelines and ensure CDM additions and changes comply with them. S/he will serve as a liaison between Finance, Supply Chain and HIM to ensure charges are captured and coded appropriately. S/he possesses the technical skills needed to compile and manage data from numerous disparate information systems.

Required Expereince:

5+ years of related experience

Skills/Competencies:

Experience Medicare and Medicaid services (CMS) rules and regulations, coding and billing compliance; working

knowledge of the HCFA-1500 and the UB-04 claim forms.

Demonstrated knowledge of revenue cycle business processes, including scheduling, registration, documentation, coding charge entry, billing collections and reimbursement.

Demonstrated ability to interpret analyze, develop, direct and implement action to comply with proposed or final

Medicare regulations.

Understands charging processes and compliance issues and has the ability to provide resolutions by performing internet

research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines.

Demonstrated intermediate to advanced skills in Excel, Microsoft Word and Outlook, Powerpoint

Excellent verbal and written communication skills and Excellent interpersonal and communication skills including abilityto resolve conflicts with tact and diplomacy, work with all levels of management.

Excellent project management, problem solving and analytical skills

Ability to work independently, identify and resolve problems

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Non-Graduate (Required)

Certifications:

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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