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 charging practices. This role involves collaboration with various teams to address charge reconciliation, denial management, and compliance audits, while also providing education and support to staff regarding revenue cycle processes.

Responsibilities

• Oversight of charge reconciliation process.
• Working with charging related claim edits and Revenue Guardian checks in various Work Queues.
• Oversight of EPIC Charge Review Work Queues assigned to clinical areas.
• Reviewing and correcting denials and edits related to charging and/or medical necessity with the PB and HB Denials teams.
• Coordinating PB and HB medical necessity denials educational calls.
• Assisting in response to external and internal coding and charging audits with various teams.
• Correcting conflicting coding, ambiguous documentation, and incorrect charging practices with relevant staff.
• Performing charge capture and charging compliance audits as per Revenue Integrity goals.
• Conducting root cause analysis on charging issues identified by various audits and instruments.
• Initiating CDM request process for required updates and assisting with annual CPT change CDM update process.
• Coordinating quarterly HCPCS change CDM update processes.
• Assisting with end user education for Craneware and monitoring requests.
• Acting as charging Subject Matter Expert for assigned areas.
• Developing impact modeling related to CDM change requests as needed.
• Remaining current on relevant regulations and guidelines related to coding and charging.
• Compiling and analyzing data to develop recommendations for revenue cycle opportunities.
• Communicating trends in charging and coding accuracy with leadership.
• Reviewing and revising charging guidelines to ensure compliance.
• Preparing regular charging related education for assigned areas.
• Conducting and leading special projects for revenue management.

Requirements

• Minimum of five (5) years of healthcare experience with knowledge of hospital operations & payment systems.
• Minimum of three (3) 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.
• Experience problem solving and performing root cause analysis on complex issues.
• Proven ability to communicate effectively and investigate issues.

Nice-to-haves

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

Benefits

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