ANALYST - REVENUE INTEGRITY

Revenue Analyst

The Revenue Analyst serves as a liaison between the clinical division directors and the revenue cycle team regarding revenue and compliance. The Revenue Analysts monitor all inpatient and outpatient revenue on a weekly and monthly basis looking for trends and troubleshooting anomalies. Responsible for regularly scheduled charge auditing for each assigned area. Process improvement recommendations, and ongoing communications with the clinical managers. Revenue Analysts are required to have detailed knowledge of assigned areas, including the operational functions and procedures, understanding the flow of charges, and charging information systems. Revenue Analysts are responsible for supporting and suggesting charge capture, timely charge entry and revenue improvement initiatives. Revenue Analysts must stay current with and interpret governmental regulations and billing guidelines for all service lines. Ongoing communication with the clinical directors is required for process improvement recommendations and collaboration on any regulatory and billing changes. Requires a detailed understanding of reimbursement rules for hospitals, post-acute care, and physician services. Revenue Analysts are responsible for assisting with revenue cycle systems and revenue reporting related tasks. This includes but is not limited to maintaining the charge master for all inpatient and outpatient services, systems building, testing and maintenance of all charge services, daily revenue error files, reporting, dashboards and assisting other departments with any revenue projects. Revenue Analysts collaborate daily with all areas of the revenue cycle, IT and clinical areas for all new services being built in the system based on EMR interfaces to the billing system. Charge testing is the responsibility of the analyst to ensure revenue is captured prior to project end and meeting all regulatory guidelines.

Department Summary: Responsible for maintaining and monitoring charges for 3 hospitals and all outpatient departments, following governmental regulatory guidelines. Our department ensures accurate and compliant capture of revenue from patient services by overseeing processes, people, and technology to prevent revenue leakage, reduce compliance risks, and improve financial health. This involves coordinating across clinical and financial teams, ensuring proper clinical documentation and medical coding, minimizing billing errors, and managing payer relationships to secure appropriate reimbursement according to complex regulations. This department also assists HIM and ROI with system functions and implementations. As an integral part of the revenue cycle division, we are a go-to department for reporting and data mining in both multiple revenue cycle systems and EMR. Our department collaborates closely with IT, clinical staff and finance.

Qualifications

High School Diploma or equivalent. Minimum of 2 years billing experience in a hospital setting. Experience in hospital reimbursement and charge capture. Knowledge of current Medicare and other regulatory billing guidelines. Experience in clinical and billing systems implementation required (planning, design, testing, validation, documentation, and ongoing support). Good time management skills. Ability to manage multiple demands from a variety of constituents. Critical thinker. Detail oriented. Effective communicator. Analytical problem-solving abilities. Comfortable speaking to large groups and presenting. Ability to work independently or in a team environment. Strong computer skills (Excel, Word, PowerPoint, Access, Microsoft TEAMS, internet, Health Quest Medipac, FinThrive, Cerner, Waystar, UltraQuest Reporter, Onbase).

Responsibilities

Expectations include reviewing regulatory changes regularly and when applicable to our charge master and communicating to affected departments being covered by our department. Coordinate education services to other departments within and outside of the revenue cycle. Assist finance with revenue opportunities and inquiries. Monitor revenue for assigned service lines. Performing scheduled routine charge audits for assigned clinical areas. Guide revenue cycle division with recommendations of charging processes. Conduct revenue optimization meetings for service lines to plan and implement strategies to obtain goals. Maintain all chargemasters with most current billing codes and prices according to company policies and regulatory standards on quarterly and yearly cadence. Maintain systems with accurate charge code mapping. Monitor charge capture via balance reports, error files and various other reporting. Build and test new charges in all systems collaborating with other departments. Building reports and data mining in several report writers. Accept change as needed to meet departmental goals. Training of new colleagues and other departments as needed. Meeting all independent and department goals. Meeting all project deadlines. Prepare or assist with other projects/duties assigned. May also be expected to assist in performing other administrative tasks assigned as well as assisting other areas of the revenue cycle division or clinical services division as deemed necessary.

Working Conditions: Work eight hours a day, Monday-Friday. Flex time available. May require occasional additional hours or paid overtime to handle peak volumes which may be outside the normal business hours of operation for the department. Overtime only as needed. At home-based work environment with flexibility after onsite training and competency established. Some travel to various Aultman locations for meetings and projects. Training on site when needed. Subject to frequent interruptions. Hazardous Exposure Category Category III - Includes tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood; body fluids or tissues (although situations can be imagined or hypothesized under which anyone anywhere might encounter potential exposure to body fluids.) Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid or to be potentially exposed in some other way. Physical Addendum Demands Frequency Remarks Lifting 0-10 lbs Occasional 10-33% # Lifting 10-20 lbs Never # Lifting 20-35 lbs Never # Lifting 35-50 lbs Never # Lifting 50-75 lbs Never # Lifting 75-100 lbs Never # Lifting over 100 lbs Never # Forward Reaching Never # Overhead Reaching Never # Standing Never # Walking Occasional 10-33% For onsite meetings Sitting Continuous 66% of the day # Climbing Never # Stairs/Ladder Never # Bending/Stooping Never # Twisting/Turning Never # Kneeling/Squatting Never # Crawling Never # Pushing/Pulling 0-10 lbs Never # Pushing/Pulling 10-20 lbs Never # Pushing/Pulling 20-35 lbs Never # Pushing/Pulling 35-50 lbs Never # Pushing/Pulling 50-100 lbs Never # Pushing/Pulling over 100 lbs Never # Carrying 0-10 lbs Occasional 10-33% # Carrying 10-20 lbs Never # Carrying 20-35 lbs Never # Carrying 35-50 lbs Never # Carrying 50-100 lbs Never # Carrying over 100 lbs Never # Grasping/repetitive sustained Never # Fine motor coordination Never # Vision: Near/Far/Color Never # Hearing: ordinary conversation/other Never # All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. The organization is an EEO/AA Employer M/F/Disability/Vet. The organization will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on the organization or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the Aultman Human Resource Department and request such an accommodation.