Revenue Integrity Analyst

Baystate Health - Springfield, MA

Full-time

Springfield, MA

Hospitals

About the position

The Revenue Integrity Analyst plays a crucial role in ensuring optimal reimbursement through consistent charge capture and billing practices. Reporting directly to the Director of Revenue Integrity and Advisory Services, this position is responsible for managing the Charge Error Worklist (CEWL), Correct Code Initiative (CCI) edits, and Soarian billing edits in a timely manner. The analyst will coordinate efforts with various departments within the revenue cycle and clinical areas, analyzing the impact of denials and coding changes on financial outcomes. Additionally, the analyst will support and implement changes to the Charge Description Master (CDM) for Baystate Health hospitals and Baystate Medical Practice, performing analytical reviews of the CDM and submitted changes to ensure accurate pricing and billing code assignments. In this role, the incumbent will serve as the system administrator for the CDM application, overseeing testing and user access. They will also participate in initiatives related to hospital billing, providing advice on charge capture workflows. The analyst will be expected to monitor and report on financial results by collecting, analyzing, interpreting, and reporting key revenue management data, including conducting variance reports on a weekly and monthly basis. This position requires a high level of technical skill to compile and manage data from various information systems, ensuring that all requested modifications to the CDM are processed efficiently. The Revenue Integrity Analyst will also represent the department on projects and system implementations related to the revenue cycle, contributing valuable insights to ensure project success. They will engage in training and educational initiatives to support clinical documentation and charge optimization, while also providing resolutions for compliance issues by leveraging internet research and third-party payor regulations. Overall, this position is integral to maintaining compliance with CMS regulations and ensuring that charges are captured and coded accurately across the organization.

Responsibilities

• Ensure that all requested additions, deletions and modifications to the CDM are properly processed in a timely manner.
• Serve as the system administrator for CDM software, coordinating maintenance of the software, interfacing to the patient financial system and user access.
• Investigate and correct problems with the charging process. Provide a high level of support to other departments in the revenue cycle.
• Obtain and apply knowledge in the following Revenue Cycle Business Functions: Charge Capture, Coding, Billing, Denial Management to support revenue cycle initiatives.
• Monitor and report on the financial results by collecting, analyzing, interpreting, and reporting key revenue management data, including conducting weekly and monthly variance reports.
• Represent the department on projects and system implementations related to revenue cycle and provide valuable input to ensure success.
• Perform other duties as requested by management. Provide support to new projects that arise.
• Review Correct Coding Initiatives (CCI) and Soarian edits for trending analysis and charge capture opportunities.
• Analyze correlation between coding edits and departmental monthly charge reports.
• Provide assistance on special projects as assigned.
• Participate on training and educational initiatives regarding clinical documentation to support charge optimization.
• Provide resolutions for charging process and compliance issues by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines.
• Develop, prepare and analyze statistical reports.
• Monitor billing reports for compliance with CMS regulations and communicate findings and recommendations.

Requirements

• 5+ years of related experience in revenue integrity or a similar field.
• Experience with Medicare and Medicaid services (CMS) rules and regulations, coding and billing compliance; working knowledge of the HCFA-1500 and the UB-04 claim forms.
• Demonstrated knowledge of revenue cycle business processes, including scheduling, registration, documentation, coding charge entry, billing collections and reimbursement.
• Ability to interpret, analyze, develop, direct and implement actions to comply with proposed or final Medicare regulations.
• Understanding of charging processes and compliance issues with the ability to provide resolutions through research and referencing guidelines.
• Intermediate to advanced skills in Excel, Microsoft Word, Outlook, and PowerPoint.
• Excellent verbal and written communication skills, with strong interpersonal skills to resolve conflicts with tact and diplomacy.
• Excellent project management, problem-solving, and analytical skills.
• Ability to work independently and identify and resolve problems.