About the position
The Revenue Integrity Analyst will be responsible for managing, coordinating, and implementing Charge Capture Audit (CCA) initiatives and processes to ensure and enhance revenue cycle management and revenue protection. Through strong customer service/support, data analytics and workflow analysis, facilitates CCA processes for Acute Hospitals and Physician Network Services.
Requirements
- Bachelor's degree required.
- Three (3) years' of experience within revenue integrity preferred.
- Five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management.
- EPIC HB/PB experience preferred.
- Applicable professional certification through AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC) preferred.
- Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500.
- Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10.
- Advanced knowledge of NCCI edits, and Medicare LCD/NCDs.
- Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care.
- Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
Job Keywords
Hard Skills
- Hospital Experience
- Managed Care
- Medical Billing
- Network Service
- Support Services
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