Rev Integrity Analyst

At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

Position Summary: The role the Revenue Integrity Analyst is to assist Central Maine Healthcare (CMH) organizations in identifying and implementing process improvements in an effort to operate a best in class revenue cycle. This position serves in a key role to improve the overall effectiveness of revenue cycle policy, practices and technology platforms for all CMH organizations. The Revenue Integrity Analyst is an analytical and process improvement role with a primary focus of working on revenue cycle tasks directed by department leaders with the purpose of improving revenue cycle process outcomes specifically related to one or more of the following areas:1. Charge Master Maintenance and Accuracy2. Charge Capture Completeness, Accuracy and Reconciliation3. Payment Variance Analytics, Reporting and Prevention4. Regulatory Adherence across Revenue Cycle departments and organizationallya. Provider Based Status and Facility Enrollment5. Revenue Cycle Reporting & Analyticsa. Financial Improvement Goal Setting, Process Improvement, Tracking and Reportingb. Data Trendingc. KPI and Operational Dashboards and Reportsd. Supporting Organizational Dashboards and Reports6. Vendor Management7. Revenue Informatics developmenta. Systems Supportb. Qualityc. Trainingd. Policiese. Professional Developmentf. Workflow Redesign and EnhancementThis position requires competency in revenue cycle, financial, business, clinical or other analytical skills with a focus on key performance metrics. The primary responsibility of this role is to assist in data and information needs to show both gap in performance as well as measurement of initiatives and tactics. The Analyst will serve as a resource for teams working on major, complex performance improvement efforts that affect multiple facility and clinical practice revenue cycle protocols throughout CMH.It is critical that this position be highly effective in delivering the services described in the Job Functions and Duties and work harmoniously with leaders and staff across CMH. Effectiveness will be measured in terms of results, commitment to CMH and customer satisfaction (at all levels).Job Functions and Duties:1. Support Revenue Cycle leaders to ensure effective process review, improvement or redesign for efficient revenue cycle operations.2. Ensure development of industry best practice operating procedures with consistent application in all business units by providing industry knowledge and subject matter expertise.3. Focus of working on tasks directed by department leaders with the purpose of improving revenue cycle process outcomes.4. Requires competency in revenue cycle, financial, business, clinical or other analytical skills with a focus on key performance metrics.5. Gather requirements, analyzing findings, recommending solutions, implementing new and improved processes and recommending ongoing controls and protocols as well as monitoring the existing processes.6. Success measured in terms of assisting teams to achieve financial and other tactic, high quality output, and customer service satisfaction.7. Perform root cause analysis to understand the business issues and summarize data challenges for all CMH organizations.8. Review, reconcile, and analyze management data including vender service placements, to identify fragmented processes and make recommendations for improvement.9. Provide support for inquiries or issues related to improvement. May assist with research, diagnosis and help resolve problems and escalates to leadership as needed.10. Apply appropriate reconciliation and testing to analytical results to provide high quality and accurate results.11. Assist in data interpretation, communication, and presentations around key performance indicators.12. Assist in gap analysis and transforming data into useful information.13. Update scorecards and other data tools to help provide actionable information.14. Review and analyze functions to identify fragmented process and make recommendations for improvement.15. Identify opportunities for process improvement utilizing key indicators and will facilitate corrective action in collaboration with others.16. Assist with special analysis and projects as needed.17. Coordinate a collaborative process for the development of policies, procedures, and internal controls.18. Work collaboratively with manager / director to identify best practices and help develop performance standards that can be tracked and reported.19. Work collaboratively with management personnel to identify processes that negatively impact Revenue Cycle outcomes.Technology:1. Assist in review and optimization of current technology, support assessing and recommending new information technology solutions and or manual changes that support departmental functions.2. Work collaboratively with departmental personnel to implement systems and process changes aimed at improving Revenue Cycle performance.3. Ensure compliance with outside regulatory requirements are documented (i.e. Pricing Transparency, CMS regulations, Managed Care contract terms)Management Reporting and Monitoring:1. Populate on-going Revenue Cycle KPIs based on computer generated data and manual reports.2. Utilize departmental work plans to monitor initiative and project goals, progress, and outcomes.3. Facilitate compilation of performance metrics reporting, analyze results and recommend corrective action.Professional Development:1. Attend local and WebEx seminars to remain current in supporting the needs of revenue cycle activities.2. Remain current in data analytics knowledge by attending various seminars and classes relevant to current business needs.3. Reviews Third Party Regulatory publications to maintain knowledge base concerning compliance, billing requirements, reimbursement, industry benchmarks and coverage issues.4. Maintains current knowledge of regulatory developments involving agencies such as CMS and MHA.Communication:1. Maintains awareness of verbal/ nonverbal communication in interactions with staff, other departments, physicians (providers), patients, and families as required2. Maintains patient, staff and hospital confidentiality in all communication interactions: written, verbal, electronic and digitalCustomer Service:1. Displays positive attitude. Treats others with honesty and respect. Speaks positively in all customer interactions internal and external.Education and Experience:1. Bachelors degree required, or five (5) years related revenue cycle experience in lieu of, and2. Four (4) years of experience in Finance or Revenue CycleKnowledge, Skills, and Abilities:1. Detailed knowledge of Revenue Cycle, reimbursement, and regulatory information2. Knowledge of business analysis techniques is preferred.3. Working knowledge of all functional areas of the revenue cycle, including contract and denial management, CDM and charge capture management, coding, vendor management, registration, billing, customer service, etc. with specialized subject matter expertise in at least one area.4. Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10), and HIPAA ANSI codes (remark and adjustment codes).5. Intermediate Microsoft software knowledge and ability to train/assist end-users.6. Ability to interpret an extensive variety of instructions furnished in written, oral, diagram, or schematic form.7. Creative and outside of the box problem solver is necessary for this position.8. Flexible and able to react to ever changing priorities.9. Advanced experience with business applications such as Excel, Power Point, Visio10. Working knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.11. Working knowledge with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.12. Working knowledge of Medical Record, Financial Services and Healthcare Application technology.13. Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.14. Able to effect collaborative alliances and promote teamwork.15. Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.16. Effective organizational, planning, controlling, scheduling and project management abilities.17. Experience or proven aptitude in the management of multiple projects and priorities.18. Financial acumen with ability to extract data, ensure integrity, produce reports and utilize for communicating results and affecting change.19. Ability to positively influence change.20. Excellent communications skills, both oral and written.21. Demonstrated ability to work well with diverse people, excellent human relation skills.22. Flexible and able to react to ever changing priorities.Physical Environment:1. Most duties do not generally present an occupational risk, however, failure to follow standard procedures and safety rules may expose the employee to potential injury e.g. falls on slippery floors, etc.Physical Requirements:1. Must be in good physical condition to meet the demands of an active position including moderate walking, sitting, standing, and twisting and moderate hand/wrist motion.

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application

AT CENTRAL MAINE HEALTHCARE YOU ARE AT THE CENTER OF EVERYTHING WE DO

Our why, our purpose, drives every decision and action we take as a healthcare system. We strive everyday to deliver exceptional care, and to improve our community. We are a non-profit organization that is breaking the traditional healthcare mold by bringing our patients and their familys high value, low cost, and award-winning care while focusing on creating an exceptional experience for them; all within their communities. To accomplish this, we only hire individuals who are committed to excellence, who embody the principles of our CMH Experience Service Standards, and who are ready to step in and help their fellow team members achieve those exceptional results for our patients, their families, and the community.

Central Maine Healthcare System

The organization is broad in its footprint, with three (3) hospitals in Bridgton, Lewiston, and Rumford, and over 75 individual practices within our Medical Group. Lewistons Central Maine Medical Center is a certified and award-winning level two trauma center, along with our Central Maine Heart and Vascular Institute and the upcoming highly anticipated launch of our comprehensive state of the art cancer treatment center. Both Bridgton and Rumford Hospitals are four (4) star accredited acute care hospitals, and our Medical Group and Maine Urgent Care Centers have won multiple awards within their specialties. As a system we are a six-time winner of the Leapfrog Safety A Rating since 2019, representing some of the highest quality care and outcomes nationwide. Our awards and accolades are only possible as a result of our commitment to culture, and a focus on safety and inclusion, in each of our patients experiences and in the experiences we create within our teams.

If you are a person who is looking for a way to give back to your community, to help improve the lives of patients or those who care for our patients, want to be part of a growing organization that is setting the bar for Maine healthcare, apply to join Central Maine Healthcare today

Diversity and Equal Employment Opportunity

CMH actively promotes diversity in its workforce at all levels of the organization. We strive to create and maintain a setting where we celebrate cultural and other differences and consider them strengths of the organization. CMH is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities.