Revenue Integrity Analyst

St. Joseph's/Candler - Savannah, GA

Full-time

Savannah, GA

Hospitals

About the position

The Revenue Integrity Analyst plays a crucial role in ensuring the timely, compliant, and accurate capture of charges and claims for various payers, including governmental and non-governmental entities. This position involves resolving pre-bill claim edits, reviewing and entering accurate charges, and monitoring claims and charge capture trends. The analyst must stay updated on CMS regulations and payer requirements while applying billing and coding knowledge to complex claim scenarios. Additionally, the role includes completing projects and tasks assigned by the department Director or designee.

Responsibilities

• Review and resolve pre-billing claim edits including NCCI, MUE, and other assigned claim clearinghouse edits daily.
• Ensure charges and related items are compliant and accurate.
• Complete manual charge entry and patient account reviews as assigned.
• Resolve account checks in Meditech daily to ensure timely submission of claims to payers.
• Identify charge capture trends and claim edit trends to Revenue Integrity leadership and provide analysis and suggestions for improvement.
• Research and communicate payer updates and changes to the department and relevant areas.
• Participate in payer/managed care contract meetings to assist in denials management.
• Assist co-workers with daily or weekly responsibilities as assigned.
• Complete charge audits including post-claim reviews in the Trisus Claims Informatics tool.

Requirements

• Associates Degree - Required (Healthcare Preferred)
• Medical Terminology - Required
• 2 Years hospital revenue cycle charging, claims processing, or related experience - Required
• Knowledge of hospital billing & claim requirements, charge capture processes, CPT codes, and payer requirements - Required
• Effective problem solving and attention to detail - Required
• Proficient in basic Excel, Word, and PowerPoint - Required
• Experience with CPT/HCPCS coding, claims preparation, MUE and NCCI claims edits - Preferred
• Certified Professional Coder (CPC) or similar coding certification required or must be obtained within one year of hire.

Nice-to-haves

• Courses in computer technology, spreadsheets/project management, medical billing, and medical coding - Preferred