Senior Revenue Integrity Analyst

Highmark Health

Full-time - Mid Level

Insurance Carriers and Related Activities

About the position

The Senior Revenue Integrity Analyst plays a crucial role in providing regulatory guidance and enhancing the Revenue Cycle Center (RCC) operations for facilities and physician practices. This position focuses on optimizing procedures, ensuring compliance, and improving documentation and billing processes. The analyst will collaborate with various stakeholders, including clinical staff and leadership, to identify training needs and enhance workflows within the Revenue Cycle.

Responsibilities

• Acts as primary revenue cycle liaison for complex clinical departments and practices, monitoring charge reconciliation reports to identify trends and compliance issues.
• Performs complete revenue cycle reviews, including Charge Description Master (CDM) audits, ensuring appropriate capture and reporting of revenue and compliance with regulations.
• Leads and participates in complex projects related to revenue cycle initiatives, developing and maintaining policies, procedures, and training materials.
• Collaborates with Compliance, Budget Office, Patient Accounts, Health Information Services, Internal Audit, and other departments on revenue management initiatives.
• Develops and maintains a Quality Audit program and assists in performance of quality audits related to team members' identified areas of opportunity.

Requirements

• Bachelor's Degree in Business, Healthcare, or related field OR six (6) years of related experience in lieu of a degree.
• 5 years of experience in hospital or physician revenue cycle, billing, coding, or billing.
• Experience with electronic health records (EPIC).

Nice-to-haves

• 3 years in an Epic-billing environment.
• 3 years with specific emphasis on regulatory issue and policy development, advanced knowledge of healthcare regulatory policies.