Revenue Integrity Analyst

Description

Finance - Revenue Integrity Analyst

Department: Finance
Status: Full-time, 80 hours bi-weekly
Shift: 1st Shift

-----------------------------------------------------------------------------------------------------------------------------------

Position Summary:

The Revenue Integrity Analyst plays a vital role in ensuring ethical, accurate, and compliant revenue capture throughout the organization. This position is responsible for auditing charge capture, posting infusion and injection charges, preparing Good Faith Estimates (GFEs), insurance claim audits and working with various departments to maintain revenue integrity across the revenue cycle. This role requires strong attention to detail, analytical thinking, and comprehensive knowledge of coding and billing regulations.

Key Responsibilities:

• Works collaboratively with teams involved in front-end, mid-cycle, and back-end revenue functions, as well as all departments responsible for revenue generation.
• The Analyst must exhibit a professional attitude and maintain a positive image of the Finance Department. Strong communication and teamwork with clinical and administrative departments are essential.
• Performs special projects as assigned by the Manager of Revenue Integrity.
• Review documentation in medical records and accurately post infusion and injection charges per coding guidelines.
• Prepare Good Faith Estimates in accordance with the Federal and State No Surprise Billing Acts and internal Financial Clearance policy.
• Complete assigned worklists and tasks to support timely and accurate claims processing.
• Address inquiries from staff regarding coding, charging, modifier use, and special projects.
• Provide charging assistance and clarification to hospital departments as needed.
• Collaborate with departments on updating charges in the system.
• Assist the Manager of Revenue Integrity with charge review, research, and validation.
• Conduct audits by reviewing medical records to ensure appropriate charges are linked to services rendered.
• Ensure correct charge master items are mapped in system dictionaries that support automated charge capture.
• Document findings from audits, regardless of outcome, for statistical tracking and error rate analysis.
• Report discrepancies and participate in root cause analysis and resolution planning.
• Assist in providing education to departments based on audit outcomes to prevent recurring issues.
• Maintain current knowledge of CMS regulations, third-party payer rules, and official coding guidelines (AHA and AMA).

-----------------------------------------------------------------------------------------------------------------------------------

Requirements

• Associate’s degree preferred.
• One of the following certifications is required:
  • Registered Health Information Technologist (RHIT)
  • Certified Coding Specialist (CCS)
  • Certified Outpatient Coder (COC)
  • Certified Professional Coder (CPC)
• Candidates actively pursuing a credential must obtain it within six months of hire. Certification must be maintained after hire.
• Strong understanding of medical terminology, human anatomy, CPT/HCPCS codes, NCCI edits, and coverage determinations (LCD/NCD).
• Familiarity with provider-based billing, critical access hospital regulations, and Medicare claims processing guidelines.

-----------------------------------------------------------------------------------------------------------------------------------