Revenue Integrity Analyst

Overview

The Revenue Integrity Analyst assists the Revenue Integrity Manager who is responsible for assessing, directing, and coordinating all aspects of the hospital’s revenue charging and charge maintenance (CDM) functions. The analyst performs research on process improvements in the capture and flow of charges from clinical departments through the patient bill. Ensures that consistent review and research related to coding and revenue reporting requirements with department leadership is accurate and compliant with state and federal regulatory requirements. Works with the manager and finance areas responsible for strategic pricing to maximize reimbursements.

Position Summary

Knowledge, Skills, and Abilities Required:

• Problem solving/analytical skills to assess operational needs and assist with the implementation of processes, protocols, and tools to meet the identified needs.
• Coding and pricing of charges utilizing appropriate methodologies and accurate formulas.
• Working knowledge of billing criteria with strong understanding of regulatory and compliance related materials.
• Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one's own behavior to accommodate tasks, situations and individuals involved.
• Ability to identify and understand issues, problems, and opportunities, comparing data from various sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints, and probable consequences.
• Demonstrates knowledge of standard Microsoft tools (Excel, Word, and PowerPoint) to support reporting, analysis, and presentations.
• Strong written and verbal communication/interpersonal skills.
• Performance of duties under minimal supervision.

Responsibilities:

• Assists with annual review of the CDM which includes identifying CPT and HCPCS Level II codes which have been deleted, added, or replaced; assigning CPT and HCPCS specific codes when appropriate; identifying description changes; and ensuring the nomenclature reflects the procedures performed.
• Assesses and identifies services that are reimbursable but are not being coded; reviews, assigns, and validates charge codes to insure proper billing.
• Assists departments with establishing processes to complete daily charge reconciliation. Monitors to ensure these processes are being performed.
• Assists manager to ensure the accuracy of pricing structures and codes as required by local, state, and federal regulations related to these changes.
• Works with revenue cycle and finance leadership to evaluate impacts on AR reduction of billed services by assisting with issues related to billing and denials that relate to charging.
• Works with the manager and Information Systems Department for the improvement and utilization of the electronic medical record and related systems as it relates to revenue improvement and charge capture.
• Works with the manager and Finance department in evaluating operational charging requirements to set strategic pricing and maximize payments within the hospital budget .
• Assists manager in maintaining reports to identify various metrics as defined by leadership or needed for departmental monitoring.
• Works with other departments to provide data, reports, assistance with projects or audits, to correct problems or enhance services.
• Develops effective relationships among internal/external stakeholders, colleagues, and staff in order to build trust and assist individuals/teams through change initiatives.
• Maintains up to date technical and market knowledge of the Clinical and coding fields through journals, seminars, and other materials as applicable.
• Performs other duties as assigned.

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. This position reports under the scope of the Revenue Integrity Manager.

Qualifications

Education and Qualifications:

• Requires a minimum of 3-5 years (healthcare finance or clinical) related experience, preferably in coding, revenue integrity, or as an RN.
• Bachelor’s degree in healthcare or a related field is required.
• RN or Certified Coder, preferred.
• Experience working and completing chargemaster/charge capture and revenue analytics around charge capture activities.
• Demonstrates working knowledge of revenue cycle processes, medical billing and coding processes, basic accounting principles, quantitative decision making and process

HIPAA: This position will have access to the following Protected Health Information in order to carry out the duties related to their position at Hays Medical Center based on the following criteria:

Primary – required (routine) to do the job;

Secondary – required for the job, but mostly be exception; and

None – no approved access Description of Information

Primary:

Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion Job

Financial Information/Insurance (information related to insurance, billing, and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates

Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical

Secondary:

Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes

Functional Demands:

Infection Control: Initial and Ongoing training in dealing with infection control. Trainings could include but are not limited to, blood borne pathogens, bodily fluids and biohazardous materials as it applies to your daily work environment.

Patient Interaction: Frequent