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 charge reconciliation, collaboration with various teams to address denials, conducting audits, and providing education on revenue cycle processes. The analyst will also perform root cause analysis on charging issues and communicate trends and recommendations to leadership.

Responsibilities

• Oversight of charge reconciliation process.
• Work on charging related claim edits and Revenue Guardian checks in various Work Queues.
• Manage 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/or medical necessity.
• Coordinate PB and HB medical necessity denials educational calls.
• Assist in response to external and internal coding and charging audits with various teams.
• Correct conflicting coding, ambiguous documentation, and incorrect charging practices with relevant staff.
• Perform charge capture and charging compliance audits as per Revenue Integrity goals.
• Conduct root cause analysis on charging issues identified by various audits and reports.
• Initiate CDM request process for required updates and assist with annual CPT change CDM update process.
• Coordinate quarterly HCPCS change CDM update processes.
• Assist with 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.
• Stay current on CMS, OIG, AMA, AHA, NJ Medicaid, and Commercial Payer regulations.
• Compile and analyze data to develop recommendations for revenue cycle opportunities.
• Communicate regularly with leadership on trends in charging and coding accuracy.
• Review, develop, implement, evaluate, and revise charging guidelines.
• Prepare regular charging related education for assigned departments.
• Conduct and lead special projects to facilitate revenue management.

Requirements

• Minimum of five years of healthcare experience with knowledge of hospital operations & 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.
• 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 software.
• 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