This position contributes and supports revenue integrity’s mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.

Under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst 3 plays an important role in a high-profile group tasked with improving revenue results. This position is integral to the Revenue Integrity Team to assist in ensuring patient services are accurately charged, appropriately coded, supported by clinical documentation and that the related revenue is recorded in the proper department. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed.

This position is responsible for assisting Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.

Revenue Integrity Analysis
• Leads the daily CDM maintenance activities along with annual pricing and CPT updates projects.

• Leads audit/ charge evaluations according to Director of Revenue Integrity and NAH Compliance. Meets with departmental leadership to review findings, documentation standards and recommendations for improvement. Targeted populations are identified through random sampling, focused reviews, issues identified in collaboration with various site personnel, and rotation/selection of specific clinical areas.

• Identifies charge trends and compiles information to determine focused reviews of specific departments and in turn provides and presents results.

• Responds to NAH Compliance Audits with next step recommendations and improvements.

• Assists and directly provides training and orientation in group settings as well as one-on-one.

• Plans and presents in-services to nursing, physician, and clerical personnel regarding processes, updates and reviews relating to audit findings and/or regulatory compliance.

• Coordinates with RI Analysts to complete various inquiries by departments to ensure accurate and timely responses.

• Maintains current knowledge of the Charge Description Master, clinical charging procedures, and related systems for the production of a bill/claim.

• Works closely with Denials/Appeals and Coding as need to bridge and drive results through the revenue cycle.

• Integral part in development of policies and procedures as they relate to improving processes, strengthening controls, enhancing revenue, and improving cash flow for the hospital through the work of the RI Team.

• Leads moderately complex projects related to revenue integrity initiatives.

• Interacts with clinical department directors to monitor charge capture functions across all NAH entities.

• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.

Revenue Integrity Analysis (Cont'd)
• Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents.

• Expected to identify, report, and participate in the resolution of any potential or actual revenue/charge related issues.

• Coordinate Charge Description Master (CDM) error findings with CDM team.

• Analyze complex financial data

• Identify trends in revenue cycle operations

• Evaluate revenue cycle workflows to identify areas for improvement

• Identify charge integrity, reconciliation, and charge linkages from ancillary charging systems

• Train patient financial services units on revenue cycle systems, processes, and procedures

• Contributes in support of quarterly improvement initiatives as directed by department director or team leader.

Analytics and Root Cause Analysis
• Perform quantitative and financial analysis along with audits designed to identify opportunities for improvement across the full spectrum of the Revenue Cycle

• Conduct analytical reviews to determine the net revenue effect of proposed charge master and fee schedule changes

• Perform internal billing audits to ensure correct coding/billing regulatory compliance and charge capture accuracy

• The incumbent must develop close working relationships with management and staff in Revenue Integrity, Finance, Information Technology, and Revenue and Clinical Operations, allowing them to perform deep-dive analyses and reviews that assist with identifying trends, solutions, and potential corrective action steps

• Will work both independently and have a high level of self-directed work efforts as well as be an integral part of the Revenue Integrity Team

• Participate in ongoing coordination and resolution of revenue issues as they arise

• Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations

• Assist with Cerner performance reporting, including assisting with Revenue & Usage, Enterprise Charge Reconciliation, and Volume Reports

• Assist in researching coding issues, provide guidance, and recommend solutions to account representatives.

• Analyze billing errors and denial data to identify the root cause of issues

• Work with the Revenue Integrity Team, Clinical Operations, and Patient Financial Services staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials, and ensure accurate reimbursement

• Participate in ongoing coordination and resolution of revenue issues as they arise

• Provide the Director and Manager input for the annual Revenue Integrity planning process

• Assist with additional projects as needed

Reporting
• Monitor Revenue Integrity reports and/or dashboard(s).

• Prepare and distribute monthly revenue trend reports to specific Clinical areas for follow-up

• Monitor and balance monthly charge/revenue reporting working with service lines and finance

• Summarize data and present reports to leadership

• Assist with Cerner performance reporting, including assisting with Revenue & Usage, Enterprise Charge Reconciliation, and Volume Reports

• Analyzes charge capture audit reports to verify that appropriate charges have been posted to patient accounts according to diagnosis and related procedure codes and that revenue has been routed/recorded in the appropriate department/cost center.

• Serve as liaison with departments to thoroughly define reporting and information requirements

Compliance/Safety
* Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

* Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.

* If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.

Education
Bachelor’s degree from a recognized college or university in business, healthcare or a closely related field.

Experience above minimum requirement of 5 years will be considered in lieu of education.

Certification & Licensures
Applicable professional certification through AHIMA (RHIA, RHIT,CCS), AAPC (COC, CPC), NAHRI (CHRI) or Pharmacy Technician CPhT - Required

Experience
5 years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management. - Required

Cerner experience - Preferred

Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs and 1500. Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10. Extensive knowledge of NCCI edits, and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Extensive working knowledge of health care compliance. Extensive understanding of medical terminology, anatomy and physiology along with clinic department activities. Capacity to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with facilitating to all member entities. Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership and other billing personnel.

Requires the ability to manage large complex projects assignments, investigate, analyze and resolve issues at a high level. Excellent communication, presentation, organizational, analytical and problem solving skills. Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment. Computer skills - MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.