Revenue Integrity Analyst

Revenue Integrity Analyst

The Revenue Integrity Analyst is accountable for monitoring charge capture, coding and variances between actual and expected reimbursement from payers. Accurately compiles information required to defend claims submission for specific services provided. Knowledge of state and federal laws and industry standards that relate to contracts, charge capture, and to the appeal process is vital.

Essential Functions :

• Understands the Revenue Cycle and the responsibility and goals of each area and how they impact the financial wellbeing of the organization.
• Demonstrates knowledge of compliance standards and payor specific data to properly file claims, ensuring prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients.
• Demonstrates working knowledge of interfaced, integrated Revenue Cycle software support tools.
• Verifies all necessary elements in the electronic medical record; appropriate charges for services rendered, accurate coding for services, reason for denials, denial status, and appeal and results of action taken.
• Performs prospective and retrospective audits, using appropriate tools to detect omissions or errors in charge capture, coding and billing.
• Verifies accuracy of transactions which appear on the account and communicates errors, omissions and corrections to appropriate caregivers.
• Understands the basics of outpatient Health Information coding, with emphasis on assigned specialties / departments.
• Has a working knowledge of the procedures and EHR workflows that are in place to generate charge capture, for assigned departments.
• Identifies additional or corrected information needed to process a denied claim through communications with the Revenue Cycle team or payor representatives in a timely manner, to expedite payor reimbursement.
• Works with Revenue Integrity leaders and caregivers to assure accurate and complete Charge Description Masters and Physician Fee Schedules via scheduled review.
• Provides a detailed and complete report monthly of charge capture audits, denials, appeals, follow-up and results on appealed accounts, root cause analysis of issues responsible for inaccurate charge capture or denied services.
• Participates in the planning, development, implementation, and maintenance of departmental monitoring tools
• Additional duties as assigned.

Additional Requirements :

Required :

Education - High School Diploma / GED

Experience - Healthcare Billing, Payment Processing, and Denial Management 3+ years

Preferred :

Education - Bachelors degree in healthcare management

Certification - Revenue Integrity certification through the appropriate agency within two years of employment

Physical Requirements : Sedentary work - Exerting up to 10 pounds of force occasionally and / or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category : Revenue Cycle

Job Family : Revenue Integrity