Revenue Integrity Analyst - RCO (Remote) in Galveston, Texas at University of Texas Medical Branch

REQUIRED EDUCATION & EXPERIENCE:

Minimum Qualifications:

• Bachelor's degree or equivalent in Finance, Business Administration, Health Care Administration, Nursing, or related field.
• 2 years of related experience.

Preferred Qualifications:

• Experience in professional billing or coding.
• Proficiency in Epic and Microsoft Office applications, including Excel.

JOB SUMMARY:

Develops and tracks meaningful metrics and key performance indicators for SOM and Health System departments to ensure accurate and optimal revenue capture and reimbursement. Responsibilities include interpretation of metrics and reporting, and regular communication with departments and external stakeholders on performance and improvement areas. Analysts will use appropriate tools to support charge capture, revenue reconciliation, denial management, and payment validation.

ESSENTIAL JOB FUNCTIONS:

Liaison:

• Coordinate with report writers to develop department-specific reporting on revenue and reimbursement trends, and analyze complex reports on an ongoing basis.
• Meet with department stakeholders to review reporting and assist with root cause analysis, which may result in recommended workflow or system changes to improve performance.
• In conjunction with Revenue Cycle, Finance, and Health System/SOM leadership, assume responsibility for the adoption of reporting and metric targets by supported departments.
• Provide the data necessary to drive department accountability and achievement of metrics.
• Promote process standardization across related departments in order to improve revenue capture and reimbursement.
• Coordinate with IS on completion of any build or enhancements to the system to resolve technical issues related to revenue capture and reimbursement.
• Ensure any necessary training is provided to end users in order to correct existing workflows or educate on new processes.
• Assist with strategic pricing, chargemaster maintenance, and charge capture reporting.

Denial Management:

• Coordinate with report writers to develop department-specific reporting on denials and avoidable write-offs and analyze complex reports on an ongoing basis.
• Prepare, compile, and distribute regular denial and AWO reports, and present data to appropriate stakeholders including the HB and PB Denial/AWO Committees.
• Meet with department stakeholders to review reporting and assist with root cause analysis, which may result in recommended workflow or system changes to improve performance.
• Provide trending on the types of claims denied and root causes of denials, and collaborate with team members to make recommendations for improvement and issue resolution.
• Maintain an updated issues list on behalf of the HB and PB Denial/AWO Committees, and follow up with owning areas as necessary to ensure progress and adherence to resolution plans.
• Coordinate with IS on completion of any build or enhancements to the system to resolve technical issues related to denial management.

Payment Validation:

• Maintain contract management system to ensure accurate and current contract terms.
• Perform financial analysis utilizing the contract management system to review overall payor reimbursement as compared to costs.
• Facilitate contract modeling and reimbursement impact analyses of proposed contract changes to support negotiations.
• Assess opportunities to maximize reimbursement by reviewing cost information, billing practices, and pricing strategies.
• Perform reviews of $0 balance accounts for the appropriate contractual reimbursement to ensure payment accuracy compared to expected allowables.
• Identify, resolve and escalate any major payment discrepancies or recurring errors at both aggregate and detailed level.
• Provide detailed reporting of payment variance opportunities, recoveries and trends for improving performance.
• Develop and maintain payor report card in order to assess overall performance of contracts.
• Contact identified payer sources to resolve problems or issues related to reimbursement.
• Provide frequent updates to leadership on contract performance, including risks to payor compliance with agreed-to contract terms, and current process improvement initiatives.

Marginal or Period Functions:

• Performs related duties as assigned.

KNOWLEDGE / SKILLS / ABILITIES:

• High level of customer service skills to establish and enhance positive relationships with clinical departments, Revenue Cycle, IT, Finance, and other stakeholder departments.
• Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
• Advanced skills in problem solving in a variety of settings and translation of data into actionable steps.
• Knowledge of healthcare finance fundamentals, including charging, insurance claim processing, and third-party reimbursement.
• Advanced computer skills to support analysis, data management and reporting.
• Skill in effective oral, written, and interpersonal communication.
• Skill in time management and project management.
• Ability to work efficiently under pressure.
• Ability to deal effectively with challenging situations.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
• Ability to deal effectively with constant changes and be a change agent.
• Ability to willingly accept responsibility and/or delegate responsibility.

WORKING ENVIRONMENT/EQUIPMENT:

• Standard office environment and equipment.

SALARY RANGE:

Actual salary commensurate with experience.

WORK SCHEDULE:

Remote position, Monday through Friday, 8:00 AM to 5:00 PM.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.