Revenue Integrity Analyst

Revenue Integrity Analyst

The RCO Revenue Integrity Analyst is responsible for appropriate charge capture, assigned account, claim edits and/or charge edits for an assigned service line. This position will support the maintenance of consistent charge capture or charge edits to ensure regulatory compliance and revenue optimization for assigned service line(s).

Essential Functions

• Analyzes data, develops reports, reviews trends and recommend enhancements as defined by the revenue practice leadership team.
• Participates, researches and follows-up on topics presented at department and system-wide initiatives.
• Monitors for positive or negative trends in coding, charge capture and/or editing processes to improve teams' performance. Researches and stays current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits.
• Provides education and guidance to revenue cycle and clinical operations on report development, charge capture accountability and revenue monitoring.
• Performs extensive data mining, regulatory and payer policy review, abstracting of financial and clinical information from various sources
• Skills
• Data Mining
• Healthcare regulations
• Health Insurance
• Medical terminology
• Communication
• Detail-orientated
• Problem solving
• Data Analysis
• Excel
• Collaboration
• Qualifications Required
• Demonstrated experience in a role requiring attention to detail with excellent organizational and analytical skills.
• Demonstrates flexibility and adaptability to change. Demonstrates ability to work in a clinical operational area and/or a revenue integrity team effectively supporting department outcomes.
• Experience working closely with a multi-disciplinary team to optimize patient experience and operational success.
• Preferred
• Bachelor's degree in finance, healthcare management, data science or related field from an accredited institution.
• Proficient or certified with Epic clinical or billing applications.
• Demonstrated clinical or healthcare revenue cycle experience.
• Physical Requirements
• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.