Revenue Integrity Analyst II- Physician Billing

3 weeks ago

Scarborough, United States MaineHealth Full time

Summary

  • Position Summary
  • ****Fully remote position This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between practices and charge improvement process. It is a holistic approach that guides the Maine Health Medical Group organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.
  • 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.
  • Required Minimum Knowledge, Skills, and Abilities (KSAs)
    • Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and three (3) to five (5) years' of experience within the revenue cycle. Experience above minimum requirement will be considered in lieu of education.
    • License/Certifications: Applicable professional certification through AHIMA (RHIA, RHIT, CCS, CCS-P) or AAPC (COC, CPC), Nurse (RN), or Pharmacy Technician (CPhT, PTCB strongly preferred.
    • Experience: Three (3) to five (5) years' experience in the hospital or practice setting, healthcare industry, billing, or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. Epic HB/PB experience preferred.
    • Proficiencies: Advanced knowledge of revenue cycle processes and hospital/medical billing to include UB, RAs and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
    • Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical -thinking and the ability to meet deadlines while influencing, but not directly managing the work of others. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Additional Information

MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org

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