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Revenue Integrity Analyst III

3 months ago

Scarborough, United States MaineHealth Full time

Summary

Position Summary

This position contributes and supports Revenue Integrity's mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and the charge improvement process. It is a holistic approach that guides the Maine Health organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst III plays an important role in a high-profile group tasked with improving revenue results. This position is integral to the Revenue Integrity Team to assist in ensuring patient services are accurately charged, appropriately coded, supported by clinical documentation and that the related revenue is recorded in the proper department. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed.

This position is responsible for assisting Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

    1. Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and five or more (5+) years of experience within the revenue cycle and coding.
    2. Certification: Applicable professional certification through AHIMA (RHIA, RHIT,CCS) or AAPC (COC, CPC), Pharmacy Technician CPhT, or Nursing credential (RN).
    3. Experience: Five (5) or more years' experience in the hospital setting, healthcare industry or coding with a focus on one or more of the following areas: coding; charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management. EPIC HB/PB experience preferred.
    4. Proficiencies: Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs and 1500. Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10. Extensive knowledge of NCCI edits, and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Extensive working knowledge of health care compliance. Extensive understanding of medical terminology, anatomy and physiology along with clinical department activities. The ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with assistance for all member entities. The ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing personnel.
    5. Abilities: Requires the ability to manage large complex projects assignments, investigate, analyze and resolve issues at a high level. Excellent communication, presentation, organizational, analytical and problem-solving skills. Must approach problem-solving challenges independently, have strong attention to detail and enjoy working in a fast-paced, collaborative team-based environment. Computer skills - MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and the Internet.

Additional Information

With a career at any of the MaineHealth locations across Maine and New Hampshire, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the communities that surround it.

We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow - programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.

MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you're looking to build a career in a place where people help one another deliver best-in-class care, apply today.

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