Revenue Integrity Analyst

3 weeks ago

Baton Rouge, United States Baton Rouge General Full time

JOB PURPOSE OR MISSION: To work with each hospital department to ensure accuracy of charging


ORGANIZATIONAL CRITERIA

CRITERIA A: Right-Touch Values - Employee demonstrates the Right-Touch values in the day-to-day performance of their job.

PERFORMANCE STANDARDS:

  • Demonstrates courtesy and caring to both their external and internal customers.

  • Takes initiative in identifying customer needs before the customer asks.

  • Participates in teamwork willingly and with enthusiasm.

  • Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.

  • Keeps customers informed, answers customer questions and anticipates information needs of customers.

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CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Points of Integrity and the GHS Corporate Compliance Guidelines.

PERFORMANCE STANDARDS

  • Practices diligence in fulfilling the regulatory and legal requirements of the position and department.

  • Maintains accurate and reliable patient/organizational records.

  • Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

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CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.

PERFORMANCE STANDARDS

  • Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.

  • Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.

  • Upholds the ethical standards of the organization.



CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.

PERFORMANCE STANDARDS

  • Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.

  • Initiates or redesigns to continuously improve work processes.

  • Contributes ideas and suggestions to improve approaches to work processes.

  • Willingly participates in organization and/or department quality initiatives.

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CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.

PERFORMANCE STANDARDS

  • Effectively manages time and resources

  • Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.

  • Consistently looks for and uses resource saving processes

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CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.

PERFORMANCE STANDARDS

  • Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.

  • Employee proactively reports errors, potential errors, injuries or potential injuries.

  • Employee demonstrates departmental specific patient and employee safety standards at all times.

  • Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.



JOB FUNCTIONS

ESSENTIAL JOB FUNCTIONS include, but are not limited to:

  • Responsible for hospital revenue integrity.
PERFORMANCE STANDARDS:

  • Ensures proper charging by departments. Uses FinThrive Charge Capture Audit module to review flagged patient cases where the facility has possibly failed to appropriately capture billable services and supplies or has overcharged.

  • Follows up daily with hospital departments and HIM in order to have charging and coding issues corrected in a timely manner for expedient billing.

  • Identifies whether missed revenue is due to training issues, SMS to CDM integrity issues, etc. and acts to improve the accuracy and completeness of patient billing data.

  • Offers assistance with billing problems (not identified by CCA) and resolution, guidelines for billable services, staff training, and compliance with third-party regulations.

  • Performs Revenue Enhancement reviews to ensure charging staff captures all possible billable services performed as well as ensuring we are not charging for non-billable services/items.

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  • Responsible for chargemaster maintenance and integrity.
PERFORMANCE STANDARDS:

  • Responsible for overseeing the development, structure, and maintenance of the content of the hospital’s Charge Description Master (cdm).

  • Processes requests for changes/additions to the chargemaster submitted by department managers and verifies changes have been made in the system. Also notifies appropriate department of changes completed, ensuring timely communication.

  • Updates chargemaster as needed to ensure compliance with CMS requirements, including working with department managers to monitor adherence.

  • Utilize FinThrive Knowledgemaster to assure correct CPT/HCPCS and Revenue codes for all charges as well as make pricing recommendations.

  • Performs regular departmental reviews to ensure coding and pricing accuracy.

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  • Performs all other duties as assigned.

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EXPERIENCE REQUIREMENTS

Knowledge of hospital processes and procedures, including clinical procedures and charges.

EDUCATIONAL REQUIREMENTS

High School Diploma or GED and 4 years work experience OR degree required.


SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS

Working knowledge of Microsoft Office tools.



HIPAA REQUIREMENTS:

Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: Medical records w/o limitation both paper and electronic, patient demographics, medical records related to quality/data, patient financial information and/or 3rd party billing.

SAFETY REQUIREMENTS:

Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position.

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