Revenue Integrity Analyst II

Job Description:

The RCO Revenue Integrity Analyst II is responsible for appropriate charge capture, assigned account, claim edits and/or charge edits for an assigned service line. This position will monitor and support the maintenance of consistent charge capture or charge edits to ensure regulatory compliance and revenue optimization for assigned service line(s). This position will support the development and management of integrated charge capture workflows in partnership with senior analysts and leadership, working closely with the clinical and clinical application teams.

Video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states:
California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington.

• Analyzes data, develops reports, reviews trends and recommends enhancements as defined by the revenue practice leadership team.
• Performs extensive data mining, mentoring/training, regulatory and payer policy review, abstracting of financial and clinical information from various sources.
• Presents, researches, and follows-up on topics reviewed at department and system-wide initiative levels.
• Monitors for positive or negative trends in coding, charge capture and/or editing processes to improve teams' performance.
• Researches and stays current on CMS, federal and state regulations, payor guidelines, ensuring compliance and alignment with charge, coding and charge edits.
• Audits and evaluates system automation by comparing the charge/claim data to the clinical record.
• Leverages other system functionalities to expedite the claim processing for compliant and optimized hospital accounts.
• Evaluates, provides education and guidance to revenue cycle, revenue practice teams and clinical operations on report development, charge capture accountability and revenue monitoring.
• Mentors and supports the training of other revenue integrity analysts.

• Data Analysis
• Healthcare Regulations
• Process improvement
• Health Insurance
• CMS
• Problem solving
• Data Mining
• Excel
• Collaboration

• Current certification through AAPC, AHIMA or HFMA, or other specialty medical coding group.
• Experience in a role requiring attention to detail with excellent organizational and analytical skills.
• Demonstrated proficiency with Epic clinical and/or billing applications.
• Demonstrates ability to be flexible and adaptable to change.
• Demonstrates ability to work in a clinical operational area and/or a revenue integrity team effectively supporting department outcomes.
• Experience working closely with a multi-disciplinary team to optimize patient experience and operational success.
• Demonstrates advanced knowledge of regulation, payer policy, charge capture and/or revenue monitoring.

• Bachelor’s degree in healthcare administration, or medical, analytical field from an accredited institution. Education is verified.
• Proficient or certified with Epic clinical or billing applications.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.