Revenue Integrity Specialist

4 days ago

Somerville, Massachusetts, United States Mass General Brigham Full time
About Us

Mass General Brigham is a not-for-profit organization dedicated to delivering exceptional patient care, advancing medical research, and fostering a culture of innovation and collaboration. As a leading healthcare system, we are committed to making a positive impact on the lives of our patients, employees, and the communities we serve.

The Opportunity

We are seeking a highly skilled Revenue Integrity Analyst II to join our team. This role will play a critical part in improving revenue results by analyzing clinical and financial processes, identifying areas for improvement, and implementing effective solutions. The successful candidate will have a strong understanding of healthcare revenue cycle management, excellent analytical and communication skills, and the ability to work collaboratively with cross-functional teams.

Key Responsibilities
  1. Provide support for assigned service lines and collaborate with the 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 accurate 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 guidance, communication, and education on correct charge capture, coding, and billing processes to PHS Enterprise staff.
  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 to identify and correct deficiencies.
  8. Prepare and present findings in standard presentations to leadership and other committees.
  9. Analyze changes to coding and billing rules and regulations and adapt systems and processes accordingly.
  10. Coordinate off-site cost center meetings with Revenue Integrity team members.
  11. Attend seminars and webinars on payor regulations and annual code set changes.
Qualifications

We are seeking a highly skilled and experienced professional with a strong background in healthcare revenue cycle management. The ideal candidate will have:

  • Three to five years of experience in a hospital setting or within the healthcare industry.
  • A Bachelor's degree in finance or science or an 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

The successful candidate will possess excellent analytical, communication, and project management skills, with the ability to work collaboratively with cross-functional teams. They will also have:

  • 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.
EEO Statement

Mass General Brigham is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive work environment that values and respects the contributions of all employees. We welcome applications from qualified candidates who share our commitment to excellence and our values of patients, affordability, accountability, and service commitment, decisiveness, innovation, and thoughtful risk-taking, diversity and inclusion, integrity and respect, learning, continuous improvement, and personal growth, teamwork and collaboration.

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