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Revenue Integrity Analyst

4 weeks ago

Tustin, United States SG HOMECARE INC Full time
Job DescriptionJob DescriptionDescription:

Position Overview:

The Revenue Integrity Analyst is responsible for performing and implementing charge capture and process improvement initiatives to optimize performance and improve revenue management. This position is also responsible for conducting root cause analysis, developing corrective action plans, educating internal customers, and monitoring results. This position will collaborate with the Revenue Cycle Team to operationalize Revenue Integrity strategy and plan for improving revenue results across all departments, financial processes, functions, and interdependencies from the provision of patient care to final payments. Maintains the Chargemaster fee schedule in accordance with established coding practices and governmental regulatory requirements. Conducts quality control audits and review charge capture clinical workflows for missed revenue opportunities. Ensures CPT, HCPCS and revenue codes are accurate and compliant will all charging and billing guidelines.


Job Responsibilities:

  • Optimizing processes to ensure services rendered are accurately reported and reimbursed while maintaining compliance with all Federal and State regulations, payer policies, and coding guidelines.
  • Collaborates closely with the Revenue Cycle Team, Compliance, Information Technology (IT), Analytics, and Finance to facilitate proper coding and billing outcomes.
  • Focus on denial prevention activities and performance improvement.
  • Develops standardized charge capture processes including daily reconciliation and reporting for all clinical departments.
  • Performs root cause analysis resulting from charge capture reconciliation, audits, and the CDM to resolve payor denials, coding/billing edits, and/or other delays or reductions to cash flow.
  • Implements process improvement strategies designed to streamline workflow, automate, and optimize technologies.
  • Provides focused education to impacted stakeholders and best practice recommendations for improvement.
  • Develops standardized reporting for both leadership and Impacted departments including a dashboard of financial activity that is meaningful to the end user.
  • Monitors Key Performance Indicators (KPIs) to identify new Revenue Integrity initiatives, track performance improvement activities, recognize important trends that may impact revenue (cause and effect), and document improved performance.
  • Conducts post-implementation audits to ensure that system updates and CDM changes result in appropriate reimbursement.
  • Validates annual pricing updates to the CDM to ensure accuracy and to optimize reimbursement within budget requirements.
  • Quantifies metrics resulting from improvements made by the Revenue Integrity Team such as incremental revenue, cost savings, CDM compliance, etc.
  • Special Projects / Process Improvement Initiatives
  • Accurately enroll or update payer enrollments across the enterprise.
  • ERA/EFT/EDI enrollment.
  • Reviews and Resolves W9 and pay to address task.
  • Performs follow-up with insurance payers via phone, email, or website to resolve payer EDI/ERA/EFT issues.
  • System updates with HCPC, ICD10, Price Tables, Fee Schedules, etc.
  • Monitoring and correcting Rejections in the EHR System.
  • Performs miscellaneous job-related duties as requested.

NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties to meet the ongoing needs of the organization.

Requirements:

Minimum Qualifications:

  • Five or more years of experience with hospital billing systems and third-party billing requirements, preferred
  • Experience in revenue integrity operations, clinical charge capture, charge master, or revenue cycle operations
  • Proficiency with Microsoft Excel
  • Understanding of Medicare/Medi-Cal claims processing guidelines
  • Experience with Brightree EHR or other EHR system
  • In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle
  • Strong analytical and problem-solving abilities
  • Excellent communication, interpersonal, and collaboration skills
  • Proficiency in the use of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes
  • Understanding of DME billing or reimbursement and charge capture operation
  • Understanding of CMS regulations and ability to interpret healthcare guidelines and regulations


Physical Demands and Working Environment

The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Environment: Standard office setting; tasks are regularly performed without exposure to adverse environmental conditions; frequent interaction with staff and the general public. The role requires that you wear a headset, access and work within multiple systems while addressing callers’ concerns in real time.

Physical: Incumbents require sufficient mobility to work in an office setting; stand or sit for prolonged periods of time; operate office equipment including use of a computer keyboard; light lifting, carrying, pushing and pulling; ability to verbally communicate to exchange information.

Vision: See in the normal visual range with or without correction; vision sufficient to read computer screens and printed documents; and to operate assigned equipment.

Hearing: Hear in the normal audio range with or without correction.