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Revenue Integrity Analyst
Job Description
The Revenue Integrity Analyst ensures accurate and compliant patient billing by analyzing charge capture, coding, and claims processes, identifying revenue leakage through audits and data analysis, and implementing improvements via education and system updates, working with clinical and financial teams to optimize reimbursement and maintain payer compliance. Coordinates and implements projects and personnel-related activities. Works under the guidance of the Supervisor. Interacts with medical staff, provider offices, nursing, ancillary departments, and outside organizations.
Hours: Full-time, 40 hours a week required
Required: high School Diploma
Pay: Based on experience, starting at 54, 808.00
Responsibilities
Assists with validating annual pricing updates to the CDM to ensure accuracy and to optimize reimbursement within organizational budget requirements., Collaboration: Works across departments (clinical, IT, billing, coding) to resolve issues and implement solutions. Collaborates closely with the Revenue Integrity Team, Compliance, Hospital & Physician Business Offices, Transplant Revenue Cycle, Health Information Management (HIM), Information Technology (IT), Managed Care, and Finance to facilitate proper coding and billing outcomes., Compliance & Education: Stays updated on payer regulations (Medicare, commercial), educates staff (physicians, coders, billers), and ensures adherence to guidelines. Provides focused education to clinical and coding stakeholders and best practice recommendations for improvement., Data Analysis & Auditing: Conducts audits, analyzes claim data, reviews charge capture, and investigates variances. Conducts post-implementation audits to ensure that system updates and CDM changes result in appropriate reimbursement., Develops and Monitors Key Performance Indicators (KPIs) to identify new Revenue Integrity initiatives, track performance improvement activities, recognize important trends that may impact revenue (cause and effect), and document improved performance., Develops standardized charge capture processes including daily reconciliation and reporting for all clinical departments., Performs root cause analysis resulting from charge capture reconciliation, audits, and the CDM to resolve payor denials, coding/billing edits, and/or other delays or reductions to cash flow., Process Improvement: Develops and implements corrective actions, improves workflows, and enhances charge description master (CDM) integrity. Implements process improvement strategies designed to streamline workflow, automate, and optimize technologies., Quantifies metrics resulting from improvements made by the Revenue Integrity Team such as incremental revenue, cost savings, CDM compliance, etc., Reporting: Creates reports, tracks trends, and presents findings to leadership to drive financial performance. Develops standardized reporting for both leadership and clinical departments including a dashboard of financial activity that is meaningful to the end user., Supports the Denials Governance Committee, focusing on denial prevention activities and performance improvement., Supports the Revenue Integrity Team and strategic Revenue Cycle plan by optimizing processes to ensure services rendered are accurately reported and reimbursed while maintaining compliance with all Federal and State regulations, payer policies, and coding guidelines.
Requirements
Bachelor's Degree, High School (Required)
Compensation
Estimated Compensation Range
$54,808.00 - $84,947.20
Pay based on experience
