Revenue Integrity Certified Analyst Iv

Position Highlights

Revenue Integrity Certified Analyst IV works directly with the clinical leadership team to ensure accurate and compliant charge capture for existing and new related business opportunities. This includes the research of coding guidelines and charging process pre and post go-live. The review includes the existing volumes per charge master item, training and education on clinical documentation opportunities to meet compliance requirements, research and review of current business and upcoming new services.

This position is responsible for the oversight, management, and maintenance of the Charge Description Chargemaster (CDM) and related ancillary systems according to the government and third-party payer regulations and guidelines. It works very closely with Clinical Informatics and Clinical IT to build the CDM in all impacted systems.

Revenue Integrity Certified Analyst IV completes charge audit for the complex departments based on the priority assigned by the Revenue Integrity leadership. This position ensures a consistent charge capture and billing by applying appropriate management of Correct Coding Initiative (CCI)/Outpatient Code Editor (OCE) edits in a timely fashion.

In addition, it onboards new team members to Revenue Integrity and leads special projects and initiatives as assigned by the Mid Revenue Cycle leadership.

• Research coding on new clinical business
• Chargemaster Management
• Charge Audit
• Complex Coding
• Education and Training
• Special Projects
• All other duties as assigned

• High School Diploma/GED required.
• Minimum of ten (10) years of experience in revenue integrity processes. Related experience may include a combination of charge audit, charge master management and maintenance and account coding for payor reimbursement.

Any one of the following certifications is required upon hire:

• (CCS) Certified Coding Specialist
• (CPMA) Professional Certified Medical Auditor
• (CPC) Certified Inpatient Coder
• (COC) Certified Outpatient Coder
• (CCS-P) Certified Coding Specialist-Physician Based
• (RHIT) Reg Health Info Technician
• (RHIA) Reg Health Info Administrator
• *** Any certification not listed above, but issued from one of the approved Governing Bodies listed below, may be considered by the business to satisfy this requirement.
• (RN) Registered Nurse
• *** in lieu of certification (active) RN will satisfy the certification requirement.

• Experience with Ambulatory Payment Classification (APC) reimbursement, Center for Medicare and Medicaid Services (CMS) rules and regulations, coding and billing compliance.
• Demonstrates ability to interpret, analyze, develop, direct and implement action to comply with proposed or final Medicare regulations.
• Proficiency with financial data with billing and reimbursement related experience.
• Understands financial management and health care reporting including the relationship between the Charge Description Master (CDM), charging and cost reporting.
• Demonstrates knowledge of the charge development process and the interrelationship of cost accounting, cost management, decision support and related functions.
• Possesses a working knowledge of various payment and coding systems, particularly the Outpatient Prospective Payment System (OPPS), and Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding schemes.
• Possesses a working knowledge of hospital and professional claims forms.
• Understands charging processes and compliance issues and has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and Center of Medicare and Medicare guidelines.
• Demonstrates knowledge and proficiency of standard PC word processing, spreadsheet, database and presentation applications (e.g., Word, Excel, Access, PowerPoint) to develop, prepare and analyze statistical reports.
• Excellent project management, problem solving and analytical skills.
• Ability to work independently, identify and resolve problems.
• Excellent interpersonal and communication skills including ability to resolve conflicts with tact and diplomacy, work with all levels of management.
• Demonstrates knowledge of revenue cycle business processes, including scheduling, registration, documentation, coding, charge entry, billing, collections and reimbursement.
• Direct operations experience in one or more revenue cycle business processes (relevant consulting experience may substitute for operations experience).
• Ability to maintain patient and compliance information in strict confidence.
• Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.