Senior Business Analyst Revenue Integrity

$70,200 - $137,800/Yr

UnitedHealth Group - Owensboro, KY

Full-time - Mid Level

Remote - Owensboro, KY

Insurance Carriers and Related Activities

About the position

The Senior Business Analyst for Revenue Integrity at Optum is responsible for overseeing compliant Charge Description Master (CDM) functions, including reimbursement analysis and monitoring revenue compliance across various teams. This role involves implementing negotiated payer rates within the Hospital Billing software and ensuring the integrity of the charge capture process. The position allows for remote work flexibility and requires collaboration with clinical departments to maintain accurate charge capture and compliance with billing regulations.

Responsibilities

• Serve as an internal resource to clinical departments regarding charge capture and charge master updates.
• Ensure ongoing consistency of the Chargemaster, including accurate descriptions, coding, pricing, and changes.
• Monitor revenue compliance and evaluate charge capture processes for new and existing services.
• Participate in the resolution of revenue issues to maintain charge capture integrity.
• Maintain the corporate charge master and provide education to ensure consistency across the Bassett Healthcare Network.
• Analyze reports to identify areas for improvement and develop action plans.
• Maintain timely turnaround of Chargemaster requests, including new codes and price changes.
• Supervise Chargemaster management functions and coordinate research on coding and billing guidelines.
• Perform analyses to understand the net revenue effect of proposed Chargemaster changes.
• Disseminate CMS updates to healthcare providers and ensure timely changes to Chargemaster files.
• Conduct internal reviews to improve revenue cycle and coding integrity.
• Develop and maintain relationships with internal and external customers to ensure compliant billing.

Requirements

• High School diploma
• 10+ years of relevant experience in patient billing and revenue cycle
• 5+ years of experience with CPT/HCPCS, UB-04 Revenue Coding, and billing regulations
• 5+ years of experience with the CDM and its relationship to finance and clinical operations
• 3+ years of knowledge with Epic
• Proficient in Microsoft Office Programs, including Excel, Word, and Access

Nice-to-haves

• 10+ years of revenue cycle processes within a healthcare organization
• 5+ years of financial-related work experience
• 5+ years of CMS coding and compliance rules
• 5+ years of experience in clinical settings such as Laboratory, Radiology, or Cardiology
• Familiarity with Epic - Resolute and clinical apps

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution