Revenue Integrity Analyst II

4 weeks ago

Boston, United States Partners Healthcare System Full time

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

The Opportunity

Reporting to the Revenue Integrity Manager, the Revenue Integrity Analyst II plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, and the ability to meet deadlines while influencing, but not directly managing the work of others.

Principal Duties and Responsibilities

* Provide support for assigned service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity.
* Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payor requirements.
* Assesses the accuracy and build of all charging workflows in EPIC, including documentation, dictionaries, preference lists and other interface or third-party charging systems.
* Provides PHS Enterprise guidance, communication and education on correct charge capture, coding and billing processes.
* Leads and participates in moderately complex projects related to revenue cycle initiatives.
* Collaborates with Partners eCare (PeC), Revenue Cycle Operations staff, Compliance, Budget Office, PHS Coding, Internal Audit and other Revenue and Finance departments on revenue management initiatives.
* Analyzes Epic work/error que data and performs root cause analysis. Executes on work plans to correct identified deficiencies. Formally prepares and presents findings in standard presentation for other committees, including leadership.
* Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. Executes on work plans to adapt systems and processes to accommodate changes.
* Coordinate off site cost center meetings with Revenue Integrity team members.
* Attend seminars/webinars on payor regulations and annual code set changes.
* Professional development to include training and support of coding certifications

Qualifications

* Three to five years of experience in a hospital setting or within the healthcare industry preferred.
* Bachelor's degree in finance or science or equivalent combination of education and experience preferred.
* Applicable clinical or professional certifications/licenses such as COC, CPC or AHIMA-CCS are highly desirable.

Skills and Abilities

* Ability to review, analyze and interpret payor payment policies, billing guidelines, and state and federal regulations.


* Financial analysis application skills, including database development and report generation.


* Advanced Excel and Access skills required.


* Strong customer service skills


* Well-developed, formal presentation skills.


* Comfort in presenting to and interacting with senior levels of hospital management and with physician leaders.


* Excellent organizational and project management skills.


* Capacity to manage time effectively, attention to detail, and follow through.


* Well-developed research skills.


* Strategic thinker with business acumen.


* Advanced level root cause analysis


* Epic healthcare system experience preferred.

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