Revenue Integrity Analyst

Revenue Integrity Analyst

Location: Minneapolis United States

Job Description:

SUMMARY

We are currently seeking a Revenue Integrity Analyst to join our Revenue Integrity team. This full-time role will primarily work remotely (Days).

Purpose of this position: Maintains HHS charge master while preventing, identifying and monitoring for revenue leakage. Ensures compliance with state, local and federal regulations. Provides charging workflow support, education and feedback to clinical leaders and ancillary staff.

Current List of non-MN States where Hennepin Healthcare is an Eligible Employer: Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, North Carolina, North Dakota, New Mexico, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin.

RESPONSIBILITIES

• Understand charge master set up and ensures maintenance requirements are met
• Understand and communicate processes for accurate, compliant charge capture and documentation requirements for appropriate billing
• Maintain extensive knowledge of ICD-10-CM, CPT/HCPCs procedure coding and revenue codes along with UB-04 and 1500 billing requirements
• Monitors federal, state and local regulations and alerts appropriate stakeholders to changes
• Conducts annual cost center quality reviews leveraging reporting tools to evaluate for charge capture gaps as well as the appropriateness of services billed based on supporting documentation, procedural (CPT/HCPCS) codes selected and appropriateness of modifier usage to identify potential opportunities for revenue capture and recognize areas of compliance concern
• Develops and executes departmental review projects with measurable financial and/or compliance goals per analysis findings
• Rolls out regular updates of CPT/HCPCS and regulatory changes which includes identifying codes that have been deleted, added, or replaced and ensuring the appropriate system changes are made, supporting education presented, and proper communication is provided to all impacted stakeholders
• Work in collaboration with clinical areas, EHR, informatics, compliance, contracting, and other revenue cycle partners to ensure Revenue Integrity
• Monitor for and identify regulatory and/or reimbursement issues resolving them at root cause in an expedient and proactive manner
• Assists with onboarding and serves as an educational resource to revenue cycle, clinical leadership, MA's, RN's and other clinical staff regarding coding and billing trends and related quality metrics
• Trains, monitors and supports charge capture reconciliation processes in clinical areas
• Provide continuous quality control through work queue monitoring, variance checks, analysis, troubleshooting and detailed research
• Organizes, analyzes and presents data for the purpose of supporting clinical leadership, and other stakeholders throughout the organization to outline and institute strategies for improvement
• Other duties as assigned

QUALIFICATIONS

Minimum Qualifications

• Bachelor s degree in Business Administration, Health Care Administration or related area

• PLUS-

• 2 years of experience in health care reimbursement, financial management or coding

• OR-

• An approved equivalent combination of education and experience

Preferred Qualifications

• Minimum of three years' experience in directly related field
• Epic Certification in HB Resolute, CDM and/or and PB Resolute
• RN
• RHIA, RHIT
• CCS, CPC
• CRIP

Knowledge/ Skills/ Abilities

• Knowledge of all third-party requirements, state and federal regulations
• Knowledge of government and commercial payer requirements for accurate and compliant healthcare charging and billing
• Extensive knowledge of CPT, HCPCs, and revenue codes
• Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting)
• Knowledge of regulatory publications, how to access and interpret
• Strong analytical and problem-solving skills
• Able to present to both small and large (up to 100) groups
• Initiate judgment, make decisions and work autonomously and remain adaptable
• Consistently demonstrate strong verbal and written communication skills at all times
• Ability to create strong collaborative relationships along with solid problem solving and conflict resolution skills
• Analytical and critical thinking skills