REVENUE INTEGRITY ANALYST

Gila Regional Medical Center - Silver City, NM

Full-time - Entry Level

Silver City, NM

Hospitals

About the position

The Revenue Integrity Analyst is responsible for reviewing explanations of benefits, denials, and open accounts receivable. Under minimal supervision and according to established procedures, this position interacts daily with team members and other departments in an effort to quickly resolve outstanding account balances while enhancing the customer experience and promoting a high level of integrity and compliance for GRMC.

Responsibilities

• Maintains thorough knowledge of third-party eligibility and claim inquiry tools and applications, requirements, and regulatory guidelines.
• Audits all inquiries to confirm appropriateness of patient responsibility to ensure correct registration, coding, payment/adjustment posting, and insurance processing of claims.
• Meets all daily, monthly, and year end closing deadlines as they relate to the accounts receivable process.
• Provides guidance and training to staff in account research.
• Alerts manager of any anomalies with the integrity of accounts receivable.
• Audits all explanations of benefits to confirm appropriateness of patient responsibility to ensure correct registration, coding, payment/adjustment posting, and insurance processing of claims.
• Processes remittance, payment, and other documentation including scanning and submission of information.
• Informs manager of consistent issues as they occur and make recommendations to improve departmental quality outcomes.
• Selects priorities and organizes work and time to meet them in order of importance.
• Participates as a team member by performing additional assignments not directly related to the job description when workload requires and as directed by management.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines and regulations.
• Demonstrates attention to detail, initiative, and judgment.
• Exhibits poise, tact, and compassion dealing with patients and clients.
• Performs other duties and special projects as assigned.

Requirements

• High school diploma or equivalent GED.
• Preferred education as an RN or coder as it relates to clinic and hospital reimbursement.
• Understanding of billing and ability to support chargemaster maintenance to be compliant with CMS.
• Prior revenue cycle experience for an individual with clinical or coding background, supporting self-driven projects and caregiver engagement.
• Understanding of insurance requirements and regulations, contract benefits, credit and collection procedures, financial assistance programs, and familiarity with medical terminology, generally acquired through two to four years' experience in medical billing.
• Interpersonal skills necessary for making patient contacts and working with interruptions by co-workers or other internal customers needing assistance with patient accounts.
• Analytical and critical thinking ability to diagnose account issues and active listening skills to provide service excellence.
• Demonstrated project and time management skills and ability to work effectively over the phone and in a team environment.
• Knowledge of insurance including Medicare, Medicaid, HMO, PPO, Commercial insurance verification, and familiarity with ICD-10 coding.