Revenue Integrity Analyst II

WHY UT SOUTHWESTERN?

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report , we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career

JOB SUMMARY

The Revenue Integrity Analyst II maintains the integrity of the Revenue Integrity program to ensure compliance with Medicare/Medicaid regulations, Managed Care contractual agreements and the applicable policies of UT Southwestern University Hospital.

BENEFITS

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

PPO medical plan, available day one at no cost for full-time employee-only coverage

100% coverage for preventive healthcare-no copay

Paid Time Off, available day one

Retirement Programs through the Teacher Retirement System of Texas (TRS)

Paid Parental Leave Benefit

Wellness programs

Tuition Reimbursement

Public Service Loan Forgiveness (PSLF) Qualified Employer

Learn more about these and other UTSW employee benefits

This is a remote position and prefer that the candidate lives in TX.

Work Shift: Monday-Friday (Start time can be from 5:30am-9am) 8.5-hour day shift. This will be discussed more as part of the interview process.

EXPERIENCE AND EDUCATION

Required

Education

Bachelor's Degree from a recognized college or university in business, healthcare or a closely related field

Experience above minimum requirement will be considered in lieu of education.

Experience

5 year's experience within the revenue cycle.

Licenses and Certifications

(CPHT) CERT PHARMACY TECH Upon Hire or

(PTCB-CPHT) CERTIFIED PHARMACY TECHNICIAN Upon Hire or

(LVN) LICENSED VOCATIONAL NURSE Upon Hire or

(AHIMA-RHIA) REGISTERED HEALTH INFO ADMNSTR Applicable professional certification through AHIMA Upon Hire or

(RHIT) REGD HEALTH INFO TECHNOLO Applicable professional certification through AHIMA Upon Hire or

(CCS) CERT CODING SPECIALIST Applicable professional certification through AHIMA Upon Hire or

(COC) Certified Outpatient Coding Applicable professional certification through AAPC Upon Hire or

(CPC) CERT PROFESSIONAL CODER Applicable professional certification through AAPC Upon Hire or

(CPC-A) CERT PROF CODER-APPRENTICE Upon Hire

Preferred

Experience

6 years in excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management. EPIC HB/PB experience preferred.

JOB DUTIES

Responsible for conducting quality control audits to ensure data/documentation integrity, and communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. Performs internally defined audits to identify under/over charges; reviews charges posted to the claims against the necessary clinical documentation to identify any possible under/over charges; documents audit findings and sends results to appropriate departments.

Compile information and/or prepare reports and analyses setting forth results of date integrity findings with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action. Conducts review of accounts that have not been paid according to their contractual agreement because of denied charges; compares charges with clinical documentation to determine the validity of the denial and/or identifies any charge discrepancies; documents audit findings; posts adjustments to accounts and sends to appropriate department for rebilling and/or payment correction if necessary.

Follow up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop education strategies to promote complete and accurate clinical documentation and correct negative trends.

Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.

Monitors EPIC Revenue Integrity Dashboards. Serves as subject matter expert to leadership on issues related to Revenue Integrity.

Train and assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation.

Stay abreast of ongoing compliance trends and developments. Reports new developments to department.

Participates in moderately complex projects related to revenue integrity initiatives.

Performs other duties as assigned.

SECURITY AND EEO STATEMENT

Security

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.