Revenue Integrity Analyst - Reimbursement (PRN)

Blanchard Valley Health System - Findlay, OH

Full-time

Findlay, OH

Nursing and Residential Care Facilities

About the position

The Revenue Integrity Analyst position is designed to support optimal and compliant revenue capture for accounts generating facility or professional claims within the Revenue Cycle Division. The role involves conducting quality and productivity audits, maintaining relationships with insurance providers, and collaborating with various departments to enhance processes that minimize claim submission delays and denials. The analyst is responsible for preparing reports to meet regulatory requirements and providing education to improve revenue cycle functions.

Responsibilities

• Perform focused and random internal audits on the functions of the Revenue Cycle Division to ensure compliant practices and accurate reimbursement.
• Document identified opportunities, create reports/dashboards to trend and analyze data, and establish key performance indicators.
• Participate in external audits that may impact reimbursement and support Corporate Compliance in audit processes.
• Maintain relationships with insurance provider representatives and lead meetings to resolve outstanding claims.
• Stay current on contract terms and policy updates, and communicate necessary process changes to affected areas.
• Partner with key areas to support clean, accurate, and compliant claims.
• Assist departments with the implementation of new service lines related to coding, documentation, and charges.
• Act as an administrator for payer websites to manage access for the Revenue Integrity Department and external vendors.
• Review, approve, and post adjustments based on Denial Write-Off Approval Levels.
• Complete audits and compile reports for timely submission related to regulatory requirements.
• Create and present education to providers and clinical departments to support successful charge practices.
• Demonstrate understanding of federal, state, and third-party charging guidelines and analyze revisions to coding and billing regulations.
• Coordinate and participate in system testing related to charge capture and data flow.
• Assist in developing revenue integrity-related policies and procedures for recommendation and approval.
• Attend and participate in in-services and organizational meetings, utilizing lean management tools.

Requirements

• Associate's degree in a related field or 5+ years of relevant experience.
• Three (3)+ years of direct professional and/or facility coding or billing experience.
• CCS, CCS-P or CPC certification required within 6 months of hire date.
• CPMA certification required or achieved within 12 months of hire date.
• Knowledge of CPT/APC/HCPCS and ICD/DRG coding and reimbursement concepts.
• Knowledge of revenue cycle workflows, clinical documentation, charge capture, coding, and billing.
• Ability to research, review, analyze, and interpret Federal, State, and Local billing regulations.
• Proven competence in computer applications, including Microsoft Office and electronic health record systems.
• Ability to compile, analyze, and present data effectively to various audiences.
• Strong problem-solving, research, and analytical skills.

Nice-to-haves

• Bachelor's degree
• RHIA or RHIT certification
• Certified Professional Biller (CPB) certification
• Certification in Healthcare Revenue Integrity (CHRI)
• CPFSS certification