Revenue Integrity Analyst

3 weeks ago

Attleboro, United States Sturdy Memorial Full time

The Revenue Integrity/Charge Capture/CDM Analyst has responsibility of the areas set forth in the key responsibility section. Associate must possess requisite analytical and technical abilities to develop and maintain systems, processes and work flows, for the timely and accurate recording of hospital revenue in regards to charge capture and maintenance of the charge description master. The position works directly with the Patient Accounts and revenue generating departments. The position has collaborative work relationship with Finance, Information Systems, Health Information Management and Compliance.

Reports to: Senior Director of Revenue Cycle

Education/Training:

  • Bachelors' degree or related experience
Required Qualifications and Skills:
  • Two plus years related experience in a hospital or health system
  • Strong knowledge of medical terminology, clinical procedures (CPT/HCPC), revenue codes and claims processing, modifiers as well as Medicare regulations related to coding, billing and reimbursement methodologies.
  • Computer proficiency (Microsoft Word, Excel), Cerner and 3M preferred
  • Strong communication and organizational skills
  • Attention to detail
  • Ability to work independently in an organized and systematic manner, with attention to detail and accuracy
  • Ability to communicate technical ideas clearly and effectively with outside vendors and other Sturdy Health Fiscal and IT personnel
  • Ability to train and provide support and guidance to department staff on technical issues relating to Chargemaster and compliance with federal, state, and local regulations.
    Ability to work under pressure to meet deadlines
Preferred Qualifications and Skills:
  • Masters' preferred
KEY RESPONSIBILIES:
  • Manages the revenue charge capture to ensure efficiency and effectiveness. This includes:
  • Development of processes and procedures to assure timely and appropriate capture of all chargeable activities. (including design of procedures in ancillary clinical systems and business systems)
  • Monitoring of late charges and places procedures in place to minimize late charges.
  • Development and maintenance of a collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, to establish charge capture mechanisms, and assure orderly and timely recording of revenue.
  • Develops pricing philosophy and techniques to establish new fees for supplies and services by utilize market data and information to assist in the pricing process.
  • Manages the hospital's charge description master including maintenance of all relevant coding required for billing and reporting.
  • Maintains current working knowledge of federal and state billing regulations.
  • Maintains knowledge of contract provision in other third party managed care contracts.
  • Implements pricing changes at the beginning of fiscal year and as dictated by other circumstances.
  • Monitors departmental monthly revenue at a high level and discusses variances with clinical departments as necessary.
  • Assures that charge description meets compliance standards. This includes:
  • Manages annual CPT and HCPCS code updates
  • Identify need for charge modifications, elimination, or creation of new charges.
  • Monitor consistency of charges throughout hospital.
  • Reviews payments for contract compliance and works with Patient Accounts staff, Senior Director and Third Party Payers to correct identified mis-payments.
  • Updates and maintains contracting software to best predict accurate payments from Third Party Payers.


Other duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

AGE AND DIVERSITY RELATED CRITERIA: Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.

ABILITY TO FULFILL JOB EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.

PHYSICAL DEMANDS: Sit for long periods of time. Repeat the same movements. Use hands to control tools, such as computers. See details of objects that are less than a few feet away. Speak clearly so listeners can understand. Understand the speech of another person.

Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.

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