Revenue Integrity Analyst

Overview

Position
:
Analyst, Revenue Integrity.
Department
:
Finance, Revenue Cycle Management.
Reports To
:
Director, Revenue Integrity.
FLSA
:
Exempt.

Location:

Luminis Health facilities (implied).

Base pay range: $60,000.00/yr - $/yr. Pay range and base pay retrieved from the job description.

The candidate is responsible for overseeing and maintaining assigned system charge controls, developing enhanced charge reconciliation functions at the department level, CDM maintenance, and governmental updates related to Revenue Integrity and Compliance. Provides support to Luminis Health facilities to ensure revenue recognition, including issue resolution for assigned areas of responsibility. Communicates corrections and changes to internal and external users and provides education to facilities and internal customers.

Reviews system charge reports to identify trends, educational needs, workflow problems, and potential system issues. Generates monthly reconciliation reports and facilitates daily/weekly calls with department heads, hospital administrators, and CBOs. Ensures reconciliation issues are resolved promptly. Analyzes revenue cycle systems and reporting data to maintain reconciliation performance, compliance, user satisfaction, and efficiency. Develops and documents hospital claims review and audit policies.

Investigates provider aberrant/fraudulent billing practices using paid claim data and reviews medical records. Provides education on correct claim coding (CPT, ICD-9, ICD-10 HCPCS) as needed.

• Pulls weekly performance reports and distributes them to organizational stakeholders; analyzes and summarizes significant changes or trends.
• Generates daily reconciliation reports and facilitates calls to resolve issues.
• Manages, coordinates, updates, and implements the Charge Description Masters (CDM).
• Provides assistance and analysis to clinical management for changes to the CDM.
• Provides education and in-service training on proper CPT-4 Codes or charge codes.
• Performs other duties including account research, problem-solving, and report writing as needed.
• Reviews the charge master and updates to enhance revenue for clinical departments.
• Audits Corporate CDM against department CDM systems.
• Analyzes CDM data and assigns CPT/HCPCS and revenue codes to the Charge Master.
• Reviews revenue cycle and clinical systems to maintain charge integrity and improve efficiency for charge recognition.
• Makes CDM-related decisions requiring higher-level analysis and investigation.
• Identifies billing irregularities and recommends next steps, including discussions with hospital, vendor referrals, or onsite audits; proposes solutions to resolve billing inconsistencies.

• Educational
  : BS in Finance, Accounting or Healthcare-related field preferred.

• 2+ years experience supporting Revenue Cycle and Clinical systems.

• RHIA preferred; CPC, CCS, or COC certifications preferred; HFMA certification preferred; NAHRI certification preferred.

• Knowledge of healthcare Revenue Integrity principles
• Understanding of departmental charge structures
• Ability to perform daily charge reconciliations
• Knowledge of clinical orders as they relate to charges
• Knowledge of Revenue Integrity technological tools

Light work. Exerting up to 20 pounds of force occasionally and up to 10 pounds frequently; sedentary work with potential occasional movement of objects.

There is reasonable expectation that employees will not be exposed to blood-borne pathogens.

• Medical, Dental, and Vision Insurance
• Retirement Plan with employer match for eligible employees
• Paid Time Off
• Tuition Assistance
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more

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