Revenue Integrity Analyst II

Mass General Brigham - Somerville, MA

Full-time - Mid Level

Remote - Somerville, MA

Ambulatory Health Care Services

About the position

The Revenue Integrity Analyst II at Mass General Brigham plays a crucial role in enhancing revenue outcomes by analyzing and improving clinical and financial processes from patient care to billing. This position is part of a high-profile team that focuses on ensuring the integrity of the Charge Description Master (CDM) and compliance with various payor requirements. The analyst will work closely with clinical departments to evaluate and refine charging and coding structures, ensuring accurate revenue capture and reporting. This role requires a blend of analytical skills, project management capabilities, and strong interpersonal communication to influence and collaborate with various stakeholders without direct management authority. In this position, the analyst will assess the accuracy of charging workflows within the EPIC system, including documentation and interface systems. They will provide guidance and education on charge capture and billing processes, lead projects related to revenue cycle initiatives, and collaborate with multiple departments such as Compliance, Internal Audit, and Revenue Cycle Operations. The analyst will also analyze data from Epic work/error queues, perform root cause analysis, and prepare formal presentations of findings for leadership and committees. The role demands a proactive approach to adapting to changes in coding and billing regulations, requiring the analyst to stay informed through seminars and webinars. Professional development is encouraged, including support for obtaining coding certifications. This position is integral to the financial health of the organization, ensuring that all processes align with regulatory standards and best practices in revenue management.

Responsibilities

• Provide support for assigned service lines and perform reviews related to Charge Description Master (CDM) integrity.
• Evaluate current charging and coding structures and processes in clinical departments to ensure appropriate revenue capture and compliance.
• Assess the accuracy and build of all charging workflows in EPIC, including documentation and dictionaries.
• Provide guidance, communication, and education on correct charge capture, coding, and billing processes.
• Lead and participate in moderately complex projects related to revenue cycle initiatives.
• Collaborate with various departments on revenue management initiatives.
• Analyze Epic work/error queue data and perform root cause analysis.
• Execute work plans to correct identified deficiencies and prepare findings for presentation to committees.
• Analyze changes to coding and billing rules and regulations and adapt systems accordingly.
• Coordinate off-site cost center meetings with Revenue Integrity team members.

Requirements

• Three to five years of experience in a hospital setting or within the healthcare industry preferred.
• Bachelor's degree in finance or science or equivalent combination of education and experience preferred.
• Applicable clinical or professional certifications/licenses such as COC, CPC or AHIMA-CCS are highly desirable.
• Epic healthcare system experience preferred.
• Ability to review, analyze and interpret payor payment policies, billing guidelines, and state and federal regulations.
• Financial analysis application skills, including database development and report generation.
• Advanced Excel and Access skills required.
• Strong customer service skills and well-developed formal presentation skills.
• Excellent organizational and project management skills.

Nice-to-haves

• Experience with healthcare financial analysis and reporting.
• Familiarity with healthcare compliance regulations and standards.
• Knowledge of medical coding and billing processes.

Benefits

• Comprehensive health insurance coverage.
• 401(k) retirement savings plan with employer matching.
• Tuition reimbursement for further education.
• Professional development opportunities and training support.
• Flexible scheduling options for work-life balance.