Highmark Health - Trenton, NJ
posted about 2 months ago
Full-time - Mid Level
Trenton, NJ
Insurance Carriers and Related Activities
About the position
The Senior Revenue Integrity Analyst position at Highmark Health focuses on providing regulatory guidance and enhancing the revenue cycle processes for facilities and physician practices. The role involves optimizing procedures, ensuring compliance, and collaborating with various stakeholders to improve documentation and billing accuracy. The analyst will conduct audits, monitor trends, and lead projects related to revenue cycle integrity, while also providing education and support to clinical departments.
Responsibilities
- Act as the primary revenue cycle liaison for complex clinical departments and practices, monitoring charge reconciliation reports to identify trends and compliance issues.
- Perform complete revenue cycle reviews, including Charge Description Master (CDM) audits, to ensure accurate revenue capture and compliance with regulations.
- Lead and participate in complex projects related to revenue cycle initiatives, developing and maintaining policies and training materials.
- Collaborate with various departments such as Compliance, Budget Office, and Patient Accounts on revenue management initiatives.
- Develop and maintain a Quality Audit program, assisting in performance audits related to team members' areas of opportunity.
Requirements
- Bachelor's Degree in Business, Healthcare, or a related field, or six years of related experience in lieu of a degree.
- Five years of experience in hospital or physician revenue cycle, billing, coding, or billing processes.
- Experience with electronic health records, specifically EPIC.
Nice-to-haves
- Three years of experience in an Epic-billing environment.
- Three years of experience with a focus on regulatory issues and policy development, with advanced knowledge of healthcare regulatory policies.
