Revenue Integrity Analyst

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Location: 9 Farm Springs Rd, Farmington, CT 10566

The Revenue Integrity Analyst – Level 2 serves as an integral part of both revenue optimization and compliance within the organization through leveraging an integrated, Epic based EMR to assist in the identification, reporting and resolution of any issues stemming from or with charge capture processes for both hospital and professional outpatient services. This role typically services many of the institutes as these areas grow in size, technology requiring additional dedicated support as it relates to all elements of the revenue cycle, ensuring the financial success of these institutes.

The role services both the professional and hospital services as it relates to procedural services. Through the use of data, system reports, and analytics, this role will support the charge capture and accuracy efforts. This position will help to optimize revenue cycle processes by validating, evaluating and trending large amounts of data for presentation to all levels of the organization.

This position also serves as technical support for Revenue Integrity staff, Revenue Cycle Departments and Clinical areas.

• Evaluates current charging and coding structures and processes in revenue generating departments to ensure appropriate capture and reporting of revenue and compliance with government and third‑party payer requirements. Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents used to capture revenue.
• Analyzes denial data to identify root causes of preventable denials, develop and implement corrective action plans to address root causes, including collaborating with the clinical areas as well as other departments within revenue cycle.
• Optimizes revenue cycle processes by validating, evaluating and trending large amounts of data for presentation to all levels of the organization.
• Performs regular charge audits, identifies any trends, and implements corrective actions when appropriate. Documents findings and corrective actions and reports to the Revenue Integrity Manager.
• Provides guidance, communication and education on correct charge capture, documentation, coding and billing processes.
• Leads annual, quarterly, CPT®, HCPCS changes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement.
• Communicates CDM maintenance activities to clinical departments and information systems staff to implement necessary changes that affect charge identification, capture, reconciliation, and claim processing. Ensures changes within the charge description master (CDM) coincide and are implemented with clinical systems by reviewing flow sheets or charge capture preference lists.
• Monitors national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly.
• Leads and participates in projects and other duties related to revenue cycle initiatives and duties, including training new analysts.

This job reports to:
Manager, Revenue Integrity Analyst.

• Minimum:
  Bachelor’s Degree or equivalent healthcare experience of 10 years.
• Preferred:
  Associates degree with health management or financial emphasis and/or health services or ten (10) years of healthcare work experience.

• Minimum:
  Three to four years of progressive on‑the‑job experience in an acute care hospital.
• Preferred:
  Five (5) years in hospital‑based health care setting with experience in facility revenue cycle operations.

• Certified Coder (CCS, CPC, etc.)

• English – Strong written and verbal communication skills.

• Extensive knowledge of ICD‑10‑CM diagnostic and CPT/HCPCS procedure codes.
• Clinical information related to responsibility areas.
• Microsoft Office Products;
  Word, Excel.

• Read, write and speak English proficiently.
• Strong analytical capabilities.
• Excellent organizational…