Sr Revenue Integrity Regulatory

Job Description

Location: Chicago, Illinois

Business Unit: Rush Medical Center

Hospital: Rush University Medical Center

Department: Revenue Cycle Revenue Integrit

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)

Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).

Pay Range: $38.02 - $61.88 per hour

Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.

Summary:

Rush is seeking a Senior Revenue Integrity Regulatory & Systems Analyst to help translate complex healthcare regulations into accurate, compliant, and optimized charge capture across the organization. In this role, you'll leverage deep expertise in coding, CDM, auditing, and Epic systems to solve complex charging scenarios, identify missed revenue opportunities, and drive automation and process improvements.

You'll partner closely with compliance, operational teams, and fellow revenue integrity professionals, serving as a subject matter expert while helping improve workflows, strengthen system builds, and support accurate reimbursement. This is an excellent opportunity for someone who enjoys working at the intersection of regulation, technology, and data to make a meaningful impact in a highly collaborative healthcare environment.

The individual who holds this position exemplifies the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.

Responsibilities:

• Apply advanced understanding of regulations, NCD's. LCD's and payor concepts, along with revenue integrity concepts to make new and existing regulations actionable within the CDM, charge capture, data, and technology space

• Serve as a liaison with compliance to promote and optimize accuracy

• Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement

• Proactively assess systems, processes, and audit revenue integrity output for accuracy and implements process improvement initiatives

• Coordinate and apply regulatory knowledge for Epic optimization and Epic WQ and Charge Router automation recommendations

• Monitor Epic Revenue Integrity build to ensure alignment with regulations and charging rules

• Harness the Epic and industry best-practices promote accurate automation to reduce manual labor

• Use logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines and then propose automation, when applicable

• Analyze revenue integrity denial trends and then provide actionable preventative measures for the Epic build

• Manipulate data along with identifying and translating trends into actionable remedies

• Responsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner

• Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing

• Audit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits

• Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts

• Identify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges

• Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts

• Meets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager

• Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement

• Engages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned

Required Job Qualifications:

• Associates degree or higher with a minimum 5+ years of healthcare experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of healthcare experience working with billing, charge entry, charge capture, or CDM.

• AAPC or AHIMA certification

• Epic HB Certification within 6 months

• Proficient and functional knowledge of reviewing charges in the Epic EHR.

• Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiers

• Excellent written and oral communication skills along with problem-solving

• Proficiency with MS Office Suite

• High degree of accuracy and ability to collaborate with others

Desired Qualification(s)

• Epic Hospital Billing (HB) certification.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Position Sr Revenue Integrity Regulatory & Systems Analyst

Location US:IL:Chicago

Req ID 24032