HOSPITAL REVENUE INTEGRITY ANALYST

About the position

To facilitate the clarification of clinical documentation of all patients with inpatient status and all observation patients (medical and surgical) through concurrent interaction with physicians, nurses, ancillary, case management, and coding staffs. Works in collaboration with the health care team providing feedback and education to assist the team to improve documentation within the health record to address all conditions, procedures, and care plans to accurately reflect the condition of the patient. The documentation should support appropriate diagnosis assignment, severity of illness, risk of mortality, and reimbursement rules. Additional duties of appeal writing, department reviews, nursing education, and coverage assistance of the Revenue Integrity team. All other duties as assigned.

Responsibilities

• Facilitate clarification of clinical documentation for inpatient and observation patients.
• Collaborate with healthcare team to improve documentation in health records.
• Provide feedback and education to healthcare team members.
• Ensure documentation supports diagnosis assignment and reimbursement rules.
• Perform appeal writing and department reviews.
• Assist with nursing education and coverage for Revenue Integrity team.

Requirements

• Associate or bachelor's Degree, required.
• RN preferred; other clinical experience considered with over 3 years of CDI/Revenue Integrity experience.
• Advanced knowledge of ICD-10, CPT, HCPCS coding in clinic & hospital environments.
• 1-2 years auditing and/or documentation improvement experience.
• Experience speaking in large groups to educate physicians and clinical staff.
• CDI or Auditing Certification preferred, required within 2 years of start date.
• Knowledge of APGs, DRGs, reimbursement mandates, denial management, and appeal writing.
• Medicare compliance knowledge.
• Strong written, oral, and positive communication skills.
• Strong computer skills, proficiency in Microsoft Word, Excel, and PowerPoint.
• Data entry, abstracting, indexing, data collection, and statistical-gathering skills.
• Ability to read and communicate effectively in English.
• Ability to work effectively as a team member.

Nice-to-haves

• CDI or Auditing Certification (AHIMA/AAPC/ACDIS accepted).
• RHIA, RHIT, CPC or CCS and/or CCS-P Certificate.