Revenue Integrity Analyst
1 week ago
**Location**:Chicago, IL
**Hospital**:RUSH University Medical Center
**Department**:Revenue Cycle Revenue Integrit
**Work Type**:Full Time (Total FTE between 0.9 and 1.0)
**Shift: Shift 1**
**Work Schedule**:8 Hr (8:00:00 AM - 4:30:00 PM)
Summary:
The Revenue Integrity Analyst uses advanced knowledge of coding, CDM, charge capture, and auditing to solve complex charging scenarios, provide education and assistance to operational departments, support fellow team members, and develop processes/procedures to ensure accurate and timely capture of all chargeable procedures. The Revenue Integrity Analyst also provides high-level professional support in working advanced outpatient coding edits as well as auditing charges for service lines with potential missed revenue opportunities. The individual who holds this position exemplifies the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.
Other information:
Required Job Qualifications:
- Associates degree or higher
- Minimum 2-4 years of healthcare experience working with billing, charge entry, charge capture, or CDM
- AAPC Certification or AHIMA Certification, or Epic Software Certification.
- Proficient and functional knowledge of reviewing charges in the Epic EHR.
- Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiers
- Excellent written and oral communication skills along with problem-solving
- Proficiency with MS Office Suite
- High degree of accuracy and ability to collaborate with others
Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.
Responsibilities:
Job Responsibilities:
- Use logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines
- Responsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner
- Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing
- Audit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits
- Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts
- Identify trends, analyze to propose and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges
- Meets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager
- Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement
- Provides input and implements process improvement initiatives recognizing revenue enhancement and charge integrity opportunities
- Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement
- Engages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned
**Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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