Revenue Integrity Analyst - Full-Time

Sturdy Health - Attleboro, MA

Full-time

Attleboro, MA

About the position

The Revenue Integrity/Charge Capture/CDM Analyst is responsible for ensuring the timely and accurate recording of hospital revenue related to charge capture and the maintenance of the charge description master. This role involves collaboration with various departments, including Patient Accounts, Finance, Information Systems, and Compliance, to develop and maintain systems and processes that enhance revenue integrity.

Responsibilities

• Manage the revenue charge capture to ensure efficiency and effectiveness.
• Develop processes and procedures to assure timely and appropriate capture of all chargeable activities.
• Monitor late charges and implement procedures to minimize them.
• Develop and maintain collaborative relationships with revenue-producing departments and technical personnel to identify chargeable activities.
• Establish charge capture mechanisms and ensure orderly and timely recording of revenue.
• Develop pricing philosophy and techniques to establish new fees for supplies and services using market data.
• Manage the hospital's charge description master, including maintenance of all relevant coding for billing and reporting.
• Maintain current knowledge of federal and state billing regulations and contract provisions in managed care contracts.
• Implement pricing changes at the beginning of the fiscal year and as needed.
• Monitor departmental monthly revenue and discuss variances with clinical departments.
• Ensure charge descriptions meet compliance standards, including managing annual CPT and HCPCS code updates.
• Identify needs for charge modifications, elimination, or creation of new charges.
• Monitor consistency of charges throughout the hospital.
• Review payments for contract compliance and work with Patient Accounts staff to correct mis-payments.
• Update and maintain contracting software to predict accurate payments from Third Party Payers.

Requirements

• Bachelor's degree or related experience.
• Two plus years of related experience in a hospital or health system.
• Strong knowledge of medical terminology, clinical procedures (CPT/HCPC), revenue codes, claims processing, and Medicare regulations.
• Computer proficiency in Microsoft Word, Excel, Cerner, and 3M preferred.
• Strong communication and organizational skills.
• Attention to detail and ability to work independently in an organized manner.
• Ability to communicate technical ideas clearly and effectively with vendors and staff.
• Ability to train and provide support on technical issues relating to Chargemaster and compliance.

Nice-to-haves

• Master's degree preferred.