Remote Revenue Integrity Charge Analyst

Job Description

Location: Remote!

Hours: Need work EST M-F 8-5

Must Haves:

3-5 years minimum of revenue integrity analyst experience

Bachelor’s degree

Experience in hospital charging/billing or performance charge review preferred

Knowledge of CPT/HCPCS coding rules, Charge Master build/maintenance, Clinical charging practices, and billing regulations and practices.

Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.

Possesses working knowledge of various payment and coding systems, particularly IPPS, OPPS, HCPCS and CPT coding schemes.

Experience working with EPIC HER

Experience in multi-hospital organizations.

Experience with Optum 360 CDM Master

Certification in healthcare compliance (HCAA or AAPC's certification) and/or Coding Certification (RHIA, RHIT, CPC or CCS)

Plusses:

EPIC slicer dicer

Day-to-Day:

Position Summary: The Revenue Integrity Analyst is responsible for ensuring accurate charge capture, coding, and billing processes to optimize reimbursement and maintain compliance with industry standards. This role involves daily review of revenue integrity work queues, providing guidance and education to clinical departments, and analyzing business processes to identify inefficiencies and recommend improvements.

1. Performs daily review of revenue integrity work queues to ensure departments are charging appropriately and revenue posted is correctly.

2.Provides guidance, communication and education on correct charge capture, coding and billing processes to clinical departments leaders and providers.

3.Analyzes business, clinical, and coding processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future losses and optimize reimbursement based on compliance standards.

4. Performs pricing reviews for hospital and professional billing. Maintain and update the Charge Description Master (CDM) to ensure it is accurate, complaint, and reflective of current clinical services and procedures.

5.Participate on performance improvement activities, including conducting routine charge capture reviews of revenue generating departments and implement any suggested changes once approved by Director of Reimbursement.

6.Perform data collection, tracking and analytical duties to respond to key issues to increase revenue integrity and process efficiency in support of the strategic initiatives and goals.

7.Work collaboratively with clinicians and revenue cycle teams to understand services provided, explore and capitalize on opportunities for enhanced revenue integrity, minimize charge leakage and maximize compliant reimbursement.

8.Performs pricing reviews for hospital and professional billing.

9.Investigate/research and advise on matters relating to professional/technical billing, coding, or regulatory requirements for documenting, coding, and billing.

10.Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, CMS, etc. Coordinates communication with the Director of Reimbursement regarding regulatory or payor changes to impacted leaders.

11.Contribute to departmental and organizational special projects as assigned; including but not limited to, price transparency, PAMA analysis, etc.)

QUALIFICATIONS

Education:

• Bachelor's Degree from an accredited college or university. Candidates without a bachelor’s degree will be considered with the following substitutes:

High School Diploma or Associate Degree with seven years healthcare patient accounting experience required as noted below

Certification/Licensure:

• Certification in healthcare compliance (HCAA or AAPC's certification) and/or Coding Certification (RHIA, RHIT, CPC or CCS), preferred.

Preferred Qualifications:

•Experience in hospital charging/billing or performance charge review preferred

• Knowledge of CPT/HCPCS coding rules, Charge Master build/maintenance, Clinical charging practices, and billing regulations and practices.

• Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.

• Possesses working knowledge of various payment and coding systems, particularly IPPS, OPPS, HCPCS and CPT coding schemes.

• Experience working with EPIC HER

• Experience in multi-hospital organizations.

• Experience with Optum 360 CDM Master.

Experience:

• At least five years previous experience in a healthcare related setting with knowledge in charging and billing practices

• Must have advanced revenue code, CPT and HCPCS coding knowledge.

• Demonstrated ability to interpret, analyze, develop, direct and implement overall expectations as it relates to large scale implementations and projects.

• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including but not limited to administrative and management staff and resolve conflicts with tact and diplomacy.

• Ability to interface with all levels of the organization effectively Incorporating regulatory requirements and performing data input and analysis and QA.

• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook and Excel.

• Possess effective oral and written skills, including superb formal presentation skills.

• Well-developed research skills.

• Excellent organizational and project management skills.

• Ability to identify and redesign inefficient workflow and processes.

• Proficiency with financial data with regards to charging, billing and reimbursement.

• Ability to analyze and interpret situations and information and offer guidance and quality decisions.

• Ability to perform work independently or with minimal supervision.

Company Description

We focus on building genuine relationships and making a meaningful impact. Here's a quick summary of what we do:

Empowerment Through Opportunity: We help people find jobs that match their skills and aspirations, providing opportunities for personal and professional growth.

Comprehensive Services: We offer temporary-to-permanent hiring, cultural consulting, program management, and skill development programs, including one-on-one mentorship and classroom training1.

Values-Driven: Our core values include caring for others, high character, hard work, and leadership that serves. We believe everyone matters and strive to take care of our employees, clients, and candidates1.

Community Impact: We are committed to making a positive impact on our communities and the planet, tackling issues like equity, healthcare access, and climate change.

Working with Insight Global means being part of a company that values people, fosters growth, and strives to make a difference!

Full-time

Fully remote