Revenue Integrity Analyst - Revenue Recovery - Primary Care

Title: Revenue Integrity Analyst | Revenue Recovery - Primary Care

Location: WI, MN, or IA United States

Job Description:

Responsible for identifying opportunities or problems, process improvements and other system changes to enhance revenue cycle performance. This role will have ongoing interactions with clinical leadership, revenue cycle staff, Finance, and IT teams. The analyst works closely with revenue cycle departments to ensure that clinical departments are informed regarding regulatory changes that affect charging processes. This position is essential in collaborating with clinical areas on charge reconciliation. Must demonstrate in-depth knowledge of CPT, HCPCS, ICD-10, as well as the current local payer policies for coding, billing, and claims processing.

This role will primarily support primary care.

Major Responsibilities Include:

• Researches and analyzes both professional (PB) and Facility (HB) claims prior to new clinical services being added to ensure the appropriate reimbursement of claims. This includes all payors; to see that government regulated billing rules and payer policies are being reinforced.

• Collaborates with Clinical Operation Directors and Clinical leaders to perform charge reconciliation to ensure performed visits, procedures, and tests are appropriately billed.

• Collaborates with Clinical Operation Directors and Clinical leaders to create mitigation plans for charges that are not entered in a timely fashion to ensure we are not at risk for revenue loss.

•  Interprets existing revenue cycle policies and operating practices to make recommendations for improvement. 

• Demonstrates in depth knowledge and technical expertise in CPT, HCPCS, ICD-10, as well as current payer policies for coding, billing and claims processing, and provider-based billing rules. 

• Serves as the point of contact for complicated billing scenarios to establish proper process(es) to get the claim filed.

• Facilitate multi-department billing steering committee.  

• Oversees and helps maintain the Revenue Guardian Edits in Epic.

• Reviews Epic Dashboards to ensure all charges are captured in a timely manner, are in compliance with state and Federal guidelines and are achieved within expected window after patient discharge. 

• Identifies and works with Information Systems to rectify any claims data transmissions issues as they arise and track any changes.

• Creates, generates, and maintains ad hoc reports proactively and as requested on various transactions to ensure consistency on claims submissions and to direct chargemaster analyst as needed to update clinical charge capture in Epic. 

• Maintains extensive knowledge of current EHR technical and professional billing software modules and how it relates to all payer processes. 

• Collaborates closely with all Revenue Cycle leaders on processes, procedures, and defining improved workflows for billing and reimbursement practices and appropriate claims submission.

• Collaborates with Compliance on governmental regulated billing rules and policies to ensure new services are set up appropriately.  

What's Available:

• Fulltime, 80 hours biweekly (1.0 FTE)

• Monday-Friday core business hours

• Remote work options for residents in WI, MN, or IA only, with occasional need to work onsite for support initiatives

An Ideal Candidate Will Have:

• Education: Bachelor’s degree in Business, Healthcare Administration, Finance, or related field preferred; equivalent relevant experience may be considered in lieu of degree.

• Experience: Minimum 4 years in healthcare plus experience with clinic/hospital billing systems

• A candidate will ideally have 3-5 years or experience within Epic clinic/ hospital billing

• Certifications: Certification from a recognized professional coding or health information organization, such as AAPC or AHIMA.

• Analytical Thinking: Ability to interpret complex data and provide actionable insights.

• Communication: Strong verbal and written communication skills; comfortable presenting to executive leadership.

• Adaptability: Thrives in a dynamic environment with evolving regulations and priorities.

• Problem-Solving: Proactively identifies issues and develops innovative solutions.

• Attention to Detail: Ensures accuracy in charge capture, compliance, and financial reporting.

• Work Closely with Primary Care

In addition to the rewarding work, you'll receive:

• A highly adaptable and mission-driven organization with a work environment that supports you personally and professionally and a work culture where you are valued and appreciated

• Competitive Benefits: A comprehensive and generous benefits package (Medical, Dental, Life Ins, HSA/FSA) ensuring your comfort and well-being as a valuable team member

• Substantial retirement contribution including a 401k match & annual discretionary base contribution

• Work-Life Balance: Paid Time Off (PTO) combines vacation, sick, and personal days into one balance to allow you the flexibility to use your time off as you need

• Professional Development: Support for your career growth through Professional Development Opportunities, our Tuition Investment Program, and our Career Development Center

• Additional Employee Discounts and Perks Other benefits include a Wellness program with incentives, employer-paid life insurance and AD&D, optional short-term and long-term disability coverage, an employee assistance program, identity theft protection, pet insurance, Inspire & Celebrate colleague recognition and rewards program, a discount program, and more!

Emplify Health is comprised of two of the Midwest’s most respected healthcare systems, Bellin Health and Gundersen Health System. Once neighbors, we are now partners, united in our mission to provide exceptional care to our communities. As a not-for-profit, patient-centered healthcare network, we have headquarters in Green Bay and La Crosse, Wisconsin. Our extensive network includes 11 hospitals and more than 100 clinics, serving 67 cities and rural communities across Wisconsin, Iowa, Minnesota and Michigan’s Upper Peninsula. With over 4,500 dedicated nurses and providers, we are committed to delivering primary, specialty and emergency care, along with innovative medical education programs.