Revenue Chrg Intgrty Analyst

About the position

The Charge Integrity Analyst is responsible for a wide variety of charge-related functionality and departmental support. Analysts maintain the hospital and professional charge master and hospital fee schedules. In addition, Analysts are required to remain current on regulatory charging updates, review and revise rates annually, and analyze charging issues. Analysts are assigned to support a series of charge sources. Throughout the year, the analyst will assist departments with new charge build and resolving charging issues. Analysts monitor and work numerous work queues in Epic, recommend rule changes, and implement charge capture workflow optimizations. Analysts work with a large variety of Revenue Cycle and non-Revenue Cycle teams and individuals to support charge capture functionality and ensure proper charging practices. Projects are assigned to ensure proper build, testing, training, and monitoring of system upgrades and optimizations related to their departments. Analysts are expected to work closely and promote an atmosphere of teamwork with other members of Charge Integrity as well as their peers in Revenue Cycle, to achieve department objectives and provide stellar customer service. This position will be providing charge integrity analytics to our UMH-West location.

Responsibilities

• Ensure the Charge Master is built and maintained in accordance with hospital policies, AMA guidelines, Federal and State law and National Uniform Billing Committee standards.
• Stay current with CMS and other regulatory and payor mandated charge capture guidelines, including revenue code, CPT, HCPCS, and modifier changes.
• Learn and utilize the appropriate tools to maintain Charge Master data.
• Maintain current knowledge through reading pertinent articles, newsletters, memos, and attending seminars as needed to successfully oversee the Charge Master and ensure its proper use.
• Work with appropriate teams, committees, and personnel to maintain HB and PB Chargeable, Orderable and Performable (EAP), Hourly and Daily Bed Charge Billing Table (BCB), Cost Center Assignment Table (CCAT) and Cost Center Table (BCC), Epic Rules (Router, Claims Manager, Revenue Guardian, etc.), and Fee Schedules.
• Use standardized pricing algorithms, available benchmarking and other rate setting tools to set hospital rates.
• Learn departmental systems and workflows that interface with and/or support charge capture.
• Assist in developing and establishing new departments (including the build of their charges and charge capture and revenue routing and reconciliation tools).
• Work with Clinical Departments, Revenue Cycle peers, and other Epic teams to ensure proper charge generation from clinical systems.
• Provide support as needed to Finance and other Revenue Cycle departments.
• Participate in the design, build, and testing of new Epic work queue rules that track and identify potential charge errors.
• Monitor and work assigned Epic work queues on a timely basis, coordinating and communicating to external partners when assistance is needed with charge corrections.
• Participate in design, build, test script development, testing, training and go-live support of periodic Epic upgrades, new module implementations, system optimizations and other organizational projects.
• Maintain accurate records of all charge and fee schedule changes, including all critical correspondence pertinent to those changes.
• Act as liaison between Billing and clinical departments to investigate and resolve issues.
• Run routine and ad hoc reports, providing analysis and distributing reports as needed.
• Participate in continuous process improvement activities, identifying and supporting process change.
• Other projects and ad hoc reports as assigned.

Requirements

• Associate's degree in Business Administration, Health Administration, Health Information Management, Health Information Technology, Nursing or equivalent combination of education and work experience.
• Experience with facility reimbursement, coding process and compliance concerns related to a charge master.
• Experience as a Certified Coder, Charge Master Administrator, Revenue Integrity Specialist, Epic Analyst or Senior Biller with government payers or equivalent combination of experience.
• Demonstrated problem solving, analytical and organizational skills.
• Demonstrated ability to research root cause and recommend solutions.
• Extensive experience with Electronic Health Record clinical and billing workflows (such as Epic or Cerner).
• Extensive experience with MS Office tools with strong emphasis on advanced Excel knowledge.
• Self-starter and detail oriented with the ability to work well independently.
• Excellent communication with the ability to articulate both written and verbal communication(s).
• Strong customer service focus.
• Great attendance record.

Nice-to-haves

• Bachelor degree in Business, Health Administration, Nursing or equivalent combination of education and experience.
• RHIT, Coding certification or equivalent combination of education and experience.
• Experience with University systems including, Epic EHR (Epic), Toad DataPoint/Hyperion IR, DataMart, Outlook, payer websites.
• Proficiency in Microsoft PowerPoint, Access, Visio.
• Hospital Billing experience within the last 5 years of this posting.
• Knowledge of University Health System policies, procedures and regulations.
• Knowledge of or experience in the delivery of patient care and front-end workflows.
• Experience performing financial and billing data reviews; claim and medical record reviews; analyzing documentation, identifying areas of financial risk and potential.
• Experience interpreting and applying CMS and other third-party payer guidelines and regulations.