Revenue Integrity Analyst - Hybrid

Revenue Integrity Analyst

Reporting directly to the Manager of Revenue Integrity and working closely with the CDM Analysts, the Revenue Integrity Analyst position will be responsible for all aspects of revenue integrity for assigned institutes, cost centers, and / or departments, including the following :

• Oversight of charge reconciliation process.
• Working charging related claim edits and Revenue Guardian checks in various Work Queues.
• Oversight of EPIC Charge Review Work Queues assigned to clinical areas (e.g., high dollar and high quantity charge).
• Works with the PB and HB Denials teams to review and correct denials and edits related to charging and / or medical necessity.
• Coordinates PB and HB medical necessity denials educational calls.
• Works with the Revenue Integrity Nurse Auditors, UM / UR team and the Billing team to assist in response to external and internal coding and charging audits.
• Works with institute / department staff, Billing, Coding, Revenue Cycle Analysts, Claims Review Nurses, Clinical Documentation Improvement, and / or other relevant staff to correct conflicting coding, ambiguous documentation, and incorrect charging and charging practices.
• Performs charge capture and charging compliance audits in accordance with Revenue Integrity goals and / or workplan and on demand as assigned, initiating CDM requests and / or departmental education based on audit findings.
• Performance of root cause analysis relative to charging issues identified by charge edits, claim edits, denials, internal and external audits, or other instruments. Notes findings and report them to clinical, revenue cycle, and financial management. Initiates CDM request process for required updates by preparing request form (in excel or within the CDM tool as applicable) and forwarding to appropriate CDM Analyst.
• Assists the CDM Analysts as needed with the annual CPT change CDM update process.
• Coordinates quarterly HCPCS change CDM update processes when these changes do not pertain to charges originating from the Willow or Supply Chain systems.
• Assists with end user education for Craneware, monitoring Craneware requests, and obtaining any needed information for requests to be completed.
• Acts as charging Subject Matter Expert for assigned institutes, cost centers, and / or departments.
• Works with CDM Analysts to develop impact modeling related to CDM change requests as needed.
• Remains current on CMS, OIG, AMA, AHA, NJ Medicaid, and Commercial Payer regulations and / or guidelines related to coding and charging, including but not limited to CMS Final Rules and National Correct Coding Initiative regulations.
• Compiles and analyzes data from various sources to develop recommendations leading to potential revenue cycle opportunities, including analyses related to CDM set-up, charge capture, billing, and / or patient financial services.
• Works with the Revenue Integrity Manager and Analysts to communicate regularly with Revenue Cycle, Institute, Compliance and Financial leadership on trends in charging and coding accuracy, root cause of any inaccuracies, and potential compliance and / or financial risk.
• Reviews, develops, implements, evaluates, and revises charging guidelines to ensure compliant charging. Effectively implements recommendations and monitors results.
• Works with Revenue Integrity Manager, CDM Analyst, and Revenue Cycle Educators to prepare regular charging related education for their assigned institutes, cost centers, and / or departments.
• Assist management in examining processes to improve workflow.
• Conducts and leads special projects to facilitate revenue management as required for new facilities / acquisitions, new departments, new service lines, and changes in regulations.
• Complies with Cooper University Healthcare Policies and Procedures.
• Performs other duties as assigned by Leadership.