Revenue Integrity Analyst

Mission Regional Medical center - Chicago, IL

Chicago, IL

Hospitals

About the position

The Revenue Integrity Analyst determines the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding, by reviewing and analyzing the medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices. This review includes the verification of coding, charging and billing data for accuracy and completeness and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, claims scrubber systems, or in the payer's system. Revenue Integrity Analyst will coordinate to ensure optimum process towards maintaining a low DNFB by clarifying any process failures, i.e., clinical documentation deficiencies, late charge entry IT related technical issues, etc. This position also serves as a liaison between facility administration, patient accounts and ancillary department directors, regarding charging issues, clinical documentation issues and revenue opportunities. Providing review results and developing and coordination educational in-services for facility staff related to charging/billing issues is also a key responsibility of this position. At times, this position may collaborate with the compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.

Responsibilities

• Determine the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding.
• Review and analyze medical record documentation against the itemized bill, clinical procedures, and department documented charging practices.
• Verify coding, charging, and billing data for accuracy and completeness.
• Ensure compliance with regulatory requirements to resolve edits or exceptions detected during system processing of claims.
• Coordinate to maintain a low DNFB by clarifying process failures.
• Serve as a liaison between facility administration, patient accounts, and ancillary department directors regarding charging and clinical documentation issues.
• Provide review results and develop educational in-services for facility staff related to charging/billing issues.
• Collaborate with the compliance Analyst to perform various billing audits.

Requirements

• Bachelor's degree in Healthcare, Business or related field.
• Epic proficiency in Hospital Billing (preferred).
• Experience with PCs, word processing, spreadsheet, Analytics, and database software applications.
• Two years' experience in a role related to revenue capture/charging, auditing, coding.
• Use of an encoder software product for code assignment in an acute care setting (preferred).
• Computer data entry with 10-key and accurate typing speed of 35 wpm (preferred).
• Strong quantitative, analytical and organization skills.
• Proficient in chart review, clinical record information systems and coding methodologies.
• Ability to understand and interpret medical records, hospital bills, and the Charge Master.
• Ability to understand all ancillary department functions.
• Excellent written and verbal communication skills.
• Excellent critical thinking skills.
• Ability to work independently in a time-oriented environment.
• Computer literacy and familiarity with the operation of basic office equipment.
• Assertive personality traits to facilitate ongoing administration communication.
• Working knowledge of Medicare & Medicaid reimbursement system and coding structures (preferred).

Nice-to-haves

• Epic proficiency in Hospital Billing.
• Use of an encoder software product for code assignment in an acute care setting.
• Computer data entry with 10-key and accurate typing speed of 35 wpm.
• Working knowledge of Medicare & Medicaid reimbursement system and coding structures.