Job Description
Position Highlights:
The Revenue Integrity Certified Analyst Senior reviews and manages the operational functions of the quarterly charge audit process. This includes running reports, completing patient accounts audits and communicating the audit results to the clinical manager and the Revenue Integrity leadership.
The position reviews and completes assigned edits, simple and complex, in the billing system to ensure account resolution for timely claim submission following the Correct Code Initiative (CCI)/Outpatient Code Editor (OCE) according to the coding guidelines.
The Revenue Integrity Certified Analyst Senior serves as the backup support for Chargemaster maintenance. The position is expected to perform data analysis for optimization for process improvement as assigned by the Revenue Integrity leadership.
ESSENTIAL FUNCTIONS:
- Reviews and manages the operational functions of the quarterly charge audit process. This includes running reports, completing patient accounts audits independently and communicating the audit results to the clinical manager and the Revenue Integrity leadership.
- Reviews Correct Coding Initiatives (CCI)/Outpatient Code Editor (OCE) edits for trending analysis and charge capture opportunities.
- Reviews and completes coding for all accounts - simple and complex - edits.
- Analyzes correlation between coding edits and departmental monthly charge reports.
- Review and quantify impact of coding changes before and after implementation.
- Supports timely resolution of issues related to billing, denials and charge capture.
- Serves as the backup support for Chargemaster maintenance.
- The position is expected to perform independent data analysis for optimization and for process improvement.
- Other duties as assigned.
Minimum Requirement:
Experience:
- Minimum of six (6) years' experience in revenue integrity processes. Related experience may include a
combination of charge audit, charge master maintenance, account coding for payor reimbursement.
Education:
Licensure – Certification:
- One of the following certifications:
- CPC) Cert Professional Coder.
- (CCS) Certified Coding Specialist.
- (COC) Certified Outpatient Coder.
- (CPMA) Professional Certified Medical Auditor.
- (CCS-P) Certified Coding Spec-Physician.
- (RHIT) Reg Health Info Technician.
- (RHIA) Reg Health Info Administrator.
- *Any relevant certification from a governing body not listed above may be reviewed and considered by the business to satisfy this requirement.
- Registered Nurse (RN) *In lieu of certification (active) RN will satisfy the certification requirement.
Minimum Skills/Specialized Training Required:
- Experience with Ambulatory Payment Classification (APC) reimbursement, Center for Medicare and Medicaid Services (CMS) rules and regulations, coding and billing compliance.
- Demonstrated ability to interpret, analyze, develop, direct and implement action to comply with proposed or final Medicare regulations.
- Proficiency with financial data with billing and reimbursement related experience.
- Understands financial management and health care reporting, including the relationship between the Charge Description Master (CDM), charging and cost reporting.
- Demonstrates knowledge of the charge development process and the interrelationship of cost accounting, cost management, decision support and related functions.
- Possesses a working knowledge of various payment and coding systems, particularly the Outpatient Prospective Payment System (OPPS), and Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding schemes.
- Possesses a working knowledge of hospital and professional claims forms.
- Understands charging processes and compliance issues and has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and Center of Medicare and Medicare guidelines.
- Demonstrated knowledge of revenue cycle business processes, including scheduling, registration, documentation, coding, charge entry, billing, collections and reimbursement.
- Direct operations experience in one or more revenue cycle business processes (relevant consulting experience may substitute for operations experience).
- Ability to maintain patient and compliance information in strict confidence.
- Ability to work with & maintain confidentiality of physician, patient, patient account & personnel data.
- Demonstrates knowledge and proficiency of standard PC word processing, spreadsheet, database and presentation applications (e.g., Word, Excel, Access, PowerPoint) to develop, prepare and analyze statistical reports.
- Excellent project management, problem solving and analytical skills.
- Ability to work independently, identify and resolve problems.
- Excellent interpersonal and communication skills including ability to resolve conflicts with tact and diplomacy, work with all levels of management.
Preferred Experience:
- Experience working with Cerner and Soarian applications.
Job Tags
Full time, Local area,