Remote - Revenue Integrity Analyst

Job Description

Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time

As part of the Revenue Integrity department, the Revenue Integrity Analyst is responsible to identify and correct the processes and systems that lead to lost revenue opportunities and reduced reimbursement for the care provided to patients. As part of ensuring operational integrity of the charge posting processes the position performs and reviews regular audits that supports the maintenance and enhancement of Mosaic Life Care's charge capture, compliance and billing functions. In addition, the position explores potential charge capture workflow enhancements, the application of a consistent charge structure and reviews rate setting, according to industry standards, payer contracts, and denial trends. The position ensures that charges make it to billing by working with the departments and Technical Services to monitor that processes are in place to handle charge interface exceptions that might turn into lost revenue. The role may also be involved in the design and implementation of data extraction and analytics processes across departments and service lines that helps pinpoint potential revenue leakage. The position maximizes charge efficiency through: (1) Monitoring revenue cycle processes and staff functions; (2) Supporting Mosaic Life Care's revenue capture and integrity through evaluating the accuracy of charge capture and billing functions and staying apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of charge capture/billing workflow improvements. Resolves Epic WQs pertaining to CCI and MUE Edits, Denials, Missing Cost Center, Missing Charges, Charge Review WQs, Physician Missing Charges Reports and Revenue Guardian edits. Performs RAC audits and appeals. Assists with CDM updates; develop annual CPT/HCPC code updates and training. Performs other duties assigned.

Responsibilities

• Through continuous process improvement efforts, works to ensure that every legitimate charge for services provided makes it to billing and that proper reimbursement is received for those services;
• Works with the departments and Technical Services to ensure the flow from the department's charge capture process to billing is error free and all charges from the departments are making it to billing;
• Responsible for finding root cause reasons and proposing solutions for issues leading to revenue leakage and/or reduced reimbursement;
• Assists in overseeing Mosaic's charge capture system to promote its accuracy and integrity across revenue-generating departments;
• Works with Patient Financial Services (PFS) to review items routinely being held by the claim scrubber that are charge/coding related and comes up with recommended resolutions that helps expedite cash flow; Liaison to PFS to review denials that are charge/coding related and with Contracts if payers are not paying as expected based on contract terms due to charge/coding issues; Summarizes hospital or health system-wide charge audit findings to executive staff, board members,
• Investigates billing errors and impacts to reimbursement potentially caused by inappropriate documentation, coding, medical necessity exceptions or charging and works in collaboration to come up with an action plan to resolve;
• Coordinates the hospital charge audit and RAC process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities.
• Reviews billing workflows and works with the appropriate teams to adjust systems/workflows to better catch errors and/or omissions prior to billing to reduce the DNFB;
• Work and resolve Epic CCI/MUE Edits, Revenue Guardian edits, Missing Charges WQs, Physician Missing Charges Report, Denials, Missing Cost Centers, and Charge Review WQs.
• Monitors fluctuations of various key performance indicators that may indicate areas needing attention; Works closely with the Chargemaster Analyst to review and implement changes when charge/coding issues are identified;
• Responsible for annual review and education of CPTs/HCPCs and update the CDM accordingly.
• Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualizes process changes for service line leaders; uses hospital denials data to support findings; and/or the compliance committee in efforts to ensure all charges are properly captured and reimbursed
• Other duties as assigned

Education

• Bachelor's Degree - Finance; business, health, or public administration management; or related field; or in pursuit thereof. - Required

Work Experience

• 3 Years - Experience in hospital charge capture review, medical record review, and claims auditing, and in working with regulatory and policy compliance issues related to federal and state programs. - Required
• 2 Years - Coding experience - Required
• Clinical review experience - Preferred

Licenses and Certifications

• Certified Professional Coder (CPC) - Required within 1 Year Or
• Certified Coding Specialist-Physician-based (CCS-P) - Required within 1 Year Or
• Registered Health Information Administrator (RHIA) - Required within 1 Year Or
• Registered Health Information Technician (RHIT) - Required within 1 Year

Travel Requirements

• Travel to off-site locations may be required. - Required

Qualifications

Skills and Abilities

Essential Technical/Motor Skills

• In-depth knowledge of compliance regulations as they relate to documentation, coding, and billing requirements.
• To include in depth knowledge of CPT, HCPCS and ICD code sets.
• Thorough understanding of revenue integrity processes and their impact throughout the revenue cycle.
• Adept analytical skills, and a proven ability to develop effective solutions for complex business challenges.

Interpersonal Skills

• Strong leadership skills.
• Works effectively in a team environment.
• Excellent written and oral communication skills.
• Effective at adjusting to change, prioritizing duties, handling stress, and relating to caregivers according to Mosaic's values.

Essential Physical Requirements

Essential Mental Abilities

• Forecasting, analyzing, synthesizing, explaining, adapting, comprehending, interpreting data
• Organizational skills
• Speaking in front of groups

Essential Sensory Requirements

• Hearing, speaking, visual skills.

Exposure to Hazards

Other Skills and Abilities

About Us

Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care.

Mosaic has a wide array of benefits to meet each employee's individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.