Revenue Integrity Analyst

Cooper University Health Care - Camden, NJ

Full-time - Mid Level

Camden, NJ

Hospitals

About the position

The Revenue Integrity Analyst at Cooper University Health Care is responsible for overseeing all aspects of revenue integrity for assigned departments, ensuring compliance with coding and billing regulations. This role involves charge reconciliation, working with denial teams, conducting audits, and collaborating with various departments to improve revenue cycle processes. The analyst will also perform root cause analysis on charging issues and provide education on compliance and best practices.

Responsibilities

• Oversight of charge reconciliation process.
• Manage charge-related claim edits and Revenue Guardian checks in various Work Queues.
• Oversee EPIC Charge Review Work Queues assigned to clinical areas.
• Collaborate with PB and HB Denials teams to review and correct denials and edits related to charging and medical necessity.
• Coordinate PB and HB medical necessity denials educational calls.
• Assist in response to external and internal coding and charging audits with Revenue Integrity Nurse Auditors and Billing team.
• Perform charge capture and compliance audits according to Revenue Integrity goals.
• Conduct root cause analysis on charging issues and report findings to management.
• Assist CDM Analysts with annual CPT change CDM update process.
• Coordinate quarterly HCPCS change CDM update processes.
• Provide end-user education for Craneware and monitor requests.
• Act as charging Subject Matter Expert for assigned departments.
• Develop impact modeling related to CDM change requests as needed.
• Compile and analyze data to identify revenue cycle opportunities.
• Communicate trends in charging and coding accuracy with leadership.
• Review and revise charging guidelines to ensure compliance.
• Prepare regular charging-related education for assigned departments.
• Conduct special projects to facilitate revenue management as required.

Requirements

• Minimum of five years of healthcare experience with knowledge of hospital operations and payment systems.
• Minimum of three years of auditing, coding, CDM, revenue integrity, and/or revenue cycle management experience in a healthcare environment.
• Experience managing and resolving coding-related billing edits.
• Understanding of CDM purpose/process, ICD-10, CPT, and HCPCS coding systems.
• Experience with EHR software and understanding of clinical documentation.
• Established knowledge of Medicare and Medicaid regulations.
• Proven ability to communicate effectively and investigate complex issues.

Nice-to-haves

• Experience with Epic software.
• Writing experience in Business Intelligence applications.
• Experience with supply-chain and/or pharmacy item add process.

Benefits

• Competitive compensation rates.
• Comprehensive employee benefits programs.
• Professional development opportunities.