R1 RCM - Boise, ID
posted 3 months ago
R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services, dedicated to transforming and solving challenges across health systems, hospitals, and physician practices. As a Revenue Integrity Analyst, you will play a crucial role in ensuring accurate and optimal revenue capture for services provided by the hospital. This involves managing and maintaining the hospital's Charge Description Master (CDM), which is essential for reflecting the hospital's current offerings accurately. Your daily responsibilities will include ensuring that all services and procedures are correctly listed in the CDM, which is vital for compliance and revenue integrity. In this position, you will develop and implement pricing strategies for various services and procedures, taking into account costs, market rates, and reimbursement policies. You will also ensure that hospital policies and procedures related to billing and coding are adhered to by all relevant departments. Analyzing billing trends will be a key part of your role, as you will identify opportunities for revenue improvement and areas of potential compliance risk. Additionally, you will conduct charge capture analysis by reviewing and analyzing patient records, billing data, and financial statements to ensure accurate charge capture. Identifying discrepancies or errors in charge capture processes and rectifying them will be part of your responsibilities. You will also verify that medical codes (ICD-10, CPT, HCPCS) assigned to procedures and diagnoses are accurate and compliant with coding guidelines. Furthermore, you will analyze payer contracts and reimbursement rates to ensure that services are billed and reimbursed appropriately. This role requires a strong understanding of healthcare reimbursement methodologies, coding systems, and billing regulations, along with a commitment to continuous learning and collaboration across teams.