Revenue Integrity Analyst

GENERAL OVERVIEW:

This position performs reporting and analysis of the revenue cycle for monitoring and problem resolution; assists staff with internal and external system issues, audits and questions relative to accounts receivable; acts a primary liaison with other parties to resolve system issues and ensure compliance with all regulations; participates in department/system initiatives involving testing and other activities to ensure overall goals are met. Collaborates with  facility/department leadership on a continuum basis.   Activities include analysis (including root cause), monitoring & auditing, reporting & education with regards to Revenue Cycle training & problem resolution with all level of leadership including physicians, service line VP's, CAO's, CFO's etc. Establishes and implements appropriate internal controls to achieve complete and accurate documentation & billing processes; collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation.  Assists with maintaining the integrity of the CDM (charge description master) and the software program.         

ESSENTIAL RESPONSIBILITIES:

• Responsible for financial, statistical and operational projects; present detailed analysis of A/R performance and other financial reports and related outcomes/trends; researches and validates clinical data used to support medical necessity of billed services, conducts quality assurance reviews of various billing components, technical requirements, supporting processes, systems and required documentation; reviews outcomes with wide array of people (i.e., Practice/clinical Directors, Practice/clinical Managers, senior leadership, Coding Manager, hospital case management, managed care contracting and RCC management) and influences adjustments to current facilities, practices.  Assist with maintaining the integrity of the CDM (charge description master) and the software program. Performs other duties as assigned. (40%)
• Performs ad hoc consultative research and coordination on current issues of Revenue Cycle regulatory risk including medical necessity denials; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal and external; works collaboratively with system compliance leadership to coordinate and manage RAC and payer audit appeals. Serves as the Revenue Cycle regulatory liaison between the Practice and the RCC for efficient management of accounts receivable, point of service Revenue Cycle activity and all other areas within the Revenue Cycle area; serves as an internal audit consultant to clinical providers. Identifies barriers and implements corrective action measures in partnership with leaders to ensure positive outcomes. Provides ongoing guidance, training and support to practices and departmental Revenue Cycle staff. Works collaboratively with physicians, leadership, and health professionals to accomplish organization and Revenue Cycle and practice goals. (20%)
• Responsible for monitoring and auditing of Revenue Cycle issues; monitor facility departments, Practices and RCC staff performance relative to current Revenue Cycle policies and procedures, including medical necessity issues of billed services through sample audits; research regulatory concepts for gaps and opportunities to improve Revenue Cycle compliance; identify under- and over-charge items for immediate resolution by the provider/practice; identify areas for risk as well as improvement - conducts assessments both desk level and on site. (10%)
• Provides ongoing education to departments, practices and RCC staff concerning practice management system, coding and regulatory complexities (i.e., billing and A/R management workflows, policies and requirements); develops and implements action and educational plans to target resolution of Revenue Cycle issues; identify training needs as well as appropriate hand-off for designated topics; assist with training and implementation of PM system for newly acquired Hospitals, ASC's and practices relative to front-end Revenue Cycle edits or other systematic issues and supportive medical record documentation. (10%)
• Collaborates with Compliance, Budget Office, Patient Accounts, Health Information Services, Internal Audit and other Revenue and Finance departments on revenue management initiatives. (10%)
• Develops and maintains a Quality Audit program and associated reporting. Assists in performance of quality audits related to RI liason and charge review coordinators identified areas of opportunity. (10%)
• Other duties as assigned.

QUALIFICATIONS:

Minimum

• High School/GED
• 1-3 years in hospital or physician revenue cycle, billing, coding or billing

Preferred

• Bachelor's Degree in Business, Healthcare or related field
• 1 year in Project Management 
• 1 year in a Epic-billing environment

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Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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