Senior Revenue Integrity Analyst

Highmark Health - Santa Fe, NM

Full-time - Mid Level

Santa Fe, NM

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 within Allegheny Health Network. This position focuses on optimizing procedures, ensuring compliance, and collaborating with various stakeholders to improve clinical documentation and billing processes. The analyst will conduct thorough revenue cycle reviews, lead complex projects, and develop training materials to support the organization's revenue management initiatives.

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, providing oversight for Revenue Integrity and CDM Management policies and training materials.
• Collaborates with various departments on revenue management initiatives, including Compliance, Budget Office, and Internal Audit.
• Develops and maintains a Quality Audit program and assists in performance quality audits related to team members' areas of opportunity.

Requirements

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

Nice-to-haves

• 3 years of experience in an Epic-billing environment.
• 3 years of experience with a focus on regulatory issues and policy development, with advanced knowledge of healthcare regulatory policies.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401k plan
• Paid holidays
• Paid time off (PTO)
• Flexible scheduling