Revenue Integrity Analyst II

Thomas Jefferson University

Full-time

10,001+ employees

Educational Services

About the position

The Revenue Integrity Analyst II plays a crucial role in enhancing the accuracy, integrity, and quality of patient charges within the healthcare system. This position involves collaboration with Revenue Cycle and clinical departments to ensure compliance with governmental and commercial payer regulations, focusing on authorization, coding, and billing guidelines. The analyst is responsible for maintaining up-to-date knowledge of coding guidelines and regulatory changes, while also serving as a subject matter expert for clinical departments on revenue cycle issues.

Responsibilities

• Improve the accuracy and integrity of patient charges.
• Collaborate with Revenue Cycle and clinical departments for thorough analysis of payer regulations.
• Act as the primary liaison for clinical service lines regarding payer guidelines and regulatory requirements.
• Identify charge edit trends and recommend workflow improvements.
• Conduct focused charge review assessments for clinical departments to ensure compliance with policies.
• Develop processes to modify charge capture applications to reduce claim edits and rejections.
• Advise service-line leaders on charge code usage and revenue capture opportunities.
• Review Charge Description Master change requests for accuracy and appropriateness.
• Prepare materials for revenue cycle meetings and facilitate discussions with clinical service lines.
• Analyze Charge Description Master billing processes and identify root causes for claims issues.

Requirements

• Bachelor's or Associate's degree in Health Information Management, Business Administration, Accounting, Management, or Healthcare Administration.
• Must hold and maintain one or more credentials: RHIA, RHIT, CCS, or CPC.
• Five years of experience in a hospital setting or healthcare industry preferred.
• 1-3 years of experience related to auditing and/or coding required.
• Knowledge of Medicare/Medicaid regulations, billing, coding, and documentation requirements.
• Understanding of various reimbursement systems including IPPS, OPPS, and fee schedule.
• Strong oral and written communication skills.
• Ability to research, analyze, and interpret healthcare policies and regulations.
• Ability to document clinical workflows impacting revenue cycle.
• Excellent organizational and project management skills.

Nice-to-haves

• Applicable professional certifications from AAHAM or HFMA preferred.