Revenue Integrity Analyst II

Revenue Integrity Analyst II

This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the ECU Health organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst II plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.

Daily Functions

• Interacts with clinical department directors to monitor charge capture functions across all entities.
• Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
• Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities.
• Monitors EPIC Revenue Integrity Dashboard(s)
• Participates in moderately complex projects related to revenue integrity initiatives.
• Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity.
• Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents.
• Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Train and assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation.

General Expectations

• Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
• Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders.
• Excellent organizational and project management skills.
• Strong time management, attention to detail, and follow through.
• Well-developed research skills.
• Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
• Work effectively as a team contributor on all assignments.
• Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
• Delivers positive patient experience, where applicable.

Minimum Requirements

Required Minimum Knowledge, Skills, and Abilities (KSAs):

• Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and a minimum of three (3) years of experience within the revenue cycle. Experience of seven (7) years or higher can be substituted for the Bachelor's degree.
• License/Certifications: Applicable professional certification through AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC)or Pharmacy Technician (CPhT, PTCB).
• Experience: Three (3) to five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. EPIC HB/PB experience preferred.
• Proficiencies: Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, Ras and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
• Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical thinking and the ability to meet deadlines while influencing, but not directly managing the work of others. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Pay Range $56,617.60 - $82,528.16/year

Remote role (based out of Greenville, NC)

Monday - Friday day shift: 8:00 a.m. - 5:00 p.m.

Great Benefits