Revenue Integrity Specialist

3 weeks ago

Somerville, Massachusetts, United States Mass General Brigham Full time

About Us

At Mass General Brigham, we are committed to delivering exceptional patient care, advancing medical research, and fostering a culture of innovation and collaboration. Our organization is dedicated to providing a comprehensive continuum of care, including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities.

Our Mission

We strive to create a people-first culture that empowers our employees to achieve their full potential. Our employees are the backbone of our organization, and we are committed to providing them with the tools, resources, and support they need to succeed. We believe in fostering a culture of inclusivity, respect, and open communication, where every employee feels valued and empowered to contribute to our mission.

The Opportunity

We are seeking a highly skilled and motivated Revenue Integrity Analyst II to join our team. As a key member of our revenue integrity team, you will play a critical role in improving revenue results by taking a global view of clinical and financial processes, functions, and interdependencies. You will work closely with our revenue cycle operations staff, compliance, budget office, PHS coding, internal audit, and other revenue and finance departments to drive revenue management initiatives.

Key Responsibilities

  1. Provide support for assigned service lines and collaborate with your team to perform reviews related to Charge Description Master (CDM) integrity.
  2. Evaluate current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payor requirements.
  3. Assess the accuracy and build of all charging workflows in EPIC, including documentation, dictionaries, preference lists, and other interface or third-party charging systems.
  4. Provide PHS Enterprise guidance, communication, and education on correct charge capture, coding, and billing processes.
  5. Lead and participate in moderately complex projects related to revenue cycle initiatives.
  6. Collaborate with Partners eCare (PeC), Revenue Cycle Operations staff, Compliance, Budget Office, PHS Coding, Internal Audit, and other Revenue and Finance departments on revenue management initiatives.
  7. Analyze Epic work/error que data and perform root cause analysis. Execute on work plans to correct identified deficiencies.
  8. Analyze changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars, and publications. Execute on work plans to adapt systems and processes to accommodate changes.
  9. Coordinate off-site cost center meetings with Revenue Integrity team members.
  10. Attend seminars/webinars on payor regulations and annual code set changes.
  11. Professional development to include training and support of coding certifications.

Qualifications

We are seeking a highly skilled and motivated individual with the following qualifications:

  • Three to five years of experience in a hospital setting or within the healthcare industry.
  • Bachelor's degree in finance or science or equivalent combination of education and experience.
  • Applicable clinical or professional certifications/licenses such as COC, CPC, or AHIMA-CCS.
  • Epic healthcare system experience.

Skills and Abilities

We are looking for an individual with the following skills and abilities:

  • Ability to review, analyze, and interpret payor payment policies, billing guidelines, and state and federal regulations.
  • Financial analysis application skills, including database development and report generation.
  • Advanced Excel and Access skills.
  • Strong customer service skills.
  • Well-developed, formal presentation skills.
  • Comfort in presenting to and interacting with senior levels of hospital management and with physician leaders.
  • Excellent organizational and project management skills.
  • Capacity to manage time effectively, attention to detail, and follow through.
  • Well-developed research skills.
  • Strategic thinker with business acumen.
  • Advanced level root cause analysis.

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