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Senior Revenue Integrity Analyst

2 months ago

Tampa, Florida, United States Moffitt Cancer Center Full time

About Moffitt Cancer Center
At Moffitt Cancer Center, we are dedicated to advancing the understanding of cancer and utilizing our knowledge to aid in its prevention and treatment. Our team of over 9,000 professionals is committed to providing exceptional care to our patients while fostering an inclusive and supportive work environment. Moffitt has been recognized as one of America's Best Large Employers and Best Employers for Women by Forbes in 2023, and has received numerous accolades for its workplace culture and nursing excellence.

Position Overview
Moffitt Cancer Center is seeking a Senior Revenue Integrity Specialist. This full-time remote role is available to residents in select states. The primary responsibility of this position is to ensure accurate charge capture and billing processes to maximize reimbursement. This is achieved through effective management of Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) edits, in collaboration with various departments within the revenue cycle and clinical settings.

Key Responsibilities:

  • Conducts reviews of CCI/OCE edits to identify trends and opportunities for charge capture.
  • Completes coding for complex edits and assesses the correlation between coding edits and departmental charge reports.
  • Evaluates the impact of coding changes pre- and post-implementation.
  • Facilitates timely resolution of billing issues, denials, and charge capture discrepancies.
  • Maintains the Master Transaction Catalog within the financial system.
  • Identifies and rectifies missing or inaccurate charge codes.
  • Collaborates with management to enhance processes for updating charge codes.
  • Analyzes root causes of issues related to edits and identifies automation opportunities.
  • Works alongside clinical staff and revenue cycle departments to develop charge codes for new procedures.
  • Participates in training initiatives focused on clinical documentation for charge optimization.
  • Interprets and implements actions to comply with Medicare regulations.
  • Demonstrates proficiency in financial data and billing/reimbursement processes.
  • Possesses knowledge of various payment and coding systems, including OPPS and HCPCS.
  • Understands compliance issues related to charging processes and provides resolutions through research and coding guidelines.
Qualifications:
Experience:
  • A minimum of four years in a related healthcare field is required, with experience in clinical settings, coding, billing, or patient accounting.
  • A high school diploma or equivalent is acceptable with an additional five years of relevant experience in lieu of a bachelor's degree.
  • At least one year of experience in a healthcare provider setting is preferred.
Preferred Qualifications:
  • Experience with Cerner and Soarian applications.
  • Familiarity with coding and Charge Description Master (CDM) maintenance.
Education:
  • A Bachelor's Degree in Nursing, Finance, Health Information Management, or Business Administration is preferred.
  • A Master's Degree in a related field is desirable.
Licensure/Certification:
  • Relevant certifications such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) are preferred.
Equal Opportunity Employer:
Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. We value diversity and encourage all qualified applicants to apply.