Revenue Integrity Analyst

Pay Range:
Responsible for improving the charge capture, reimbursement, and quality of the revenue cycle through the support and management of revenue cycle applications; process automation, Charge Description Master, Claims, analysis, reporting, clinical and departmental integration, and performance of compliance, contract payment, and denials auditing.

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

Working at SEARHC is more than a job, it's a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

Key Essential Functions and Accountabilities of the Job

• Optimization and troubleshooting of revenue cycle applications
• Collaboration with clinical, operational, supporting departments, applicable stakeholders, for development of integrated design solutions
• Analysis of available data to support Revenue Cycle team initiatives in identification, definition, resolution planning, and implementation for system & user deviations, inconsistencies, and process failures
• Serves as an internal resource on a combination of the topics of registration, authorizations, coding, CDI, CDM management, claims, edits, billing compliance, denials, remittance processing, and/or reporting & analytics
• Workflow analysis
• Payer contract analysis and ensuring payments consistent with negotiated contracts
• Identification of root causes of issues driving controllable denials, partnering with finance leadership to address implicated operational issues, workflow issues, and training gaps
• Performs quality assurance and validation tasks
• Provides education and guidance to patient revenue generating departments/providers to ensure appropriate charge capture

Education, Certifications, and Licenses Required

• Bachelor's degree or an equivalent combination of education and/or work experience - Required
• 4 years of work experience may be exchanged for a bachelor's degree
• AAHAM, AAPC, AHIMA, PTCB, or other professional certification or licensure - Preferred

Experience Required

• 2 years of experience Revenue Cycle, Finance, or Clinical capacity

Knowledge of

• End user workflows including scheduling, registration, clinical, ancillary, coding, billing and claims processing, cash posting, and/or reporting
• National and International code sets including ICD 10CM, DSM, CPT, HCPCS, Revenue Codes, CARC/RARC, NCCI
• Payer edits, rejections, rules, and appropriate actions and requirements for resolution
• Billing, accounts receivable, collection practices, and/or reporting requirements for IHS, CAH, FQHC, Provider Based, LTC, Rehab, Behavioral Health (CBH, SUD, 1115), and/or Retail Pharmacy enrollments
• File structure, configuration, requirements, and troubleshooting of UB 04, CMS 1500, 837I/P, 835, and/or NCPDP D.0
• Resources, references, statutes, governing the instruction, policy, and procedure for participation in, and billing, for various State, Federal, and Commercial programs

Skills in

• Critical thinking (problem solving, troubleshooting)
• Creative solution design and execution for complex problems
• Exposure to Microsoft Office programs, including Word, Excel
• Electronic Health Record applications

Ability to

• Work on different projects simultaneously, multitasking in a fast-paced environment, appropriately handle overlapping commitments and deadlines
• Implement a systematic, self-motivated approach to problem solving
• Work independently and collaboratively as needed

Required Certifications :

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!