POSITION SUMMARY

The Revenue Integrity Analyst provides support and insight into Revenue Integrity processes including front-end avoidable denials, charge capture/reconciliation, report trending and analytics, RI training/education as needed. Responsible for the overall timely and accurate capture of patient service revenue, assists with the development or maintenance of the Charge Description Master (CDM). Focusing on implementing and supporting continuous improvement in key revenue cycle functions including Registration, Coding, and Billing. The Analyst will maintain a good working relationship with all clinical charging departments to ensure clear communication and a collaborative approach to implementing best practice processes. Serving as liaison, this position is responsible for monitoring and communicating current regulations and reporting requirements as set by government or other payers, and ensuring any changes are properly implemented through project oversight.

MINIMUM REQUIREMENTS

Education:

Bachelor's degree in Business, Finance, Healthcare or closely related field, or equivalent years’ experience.

Experience:

3-5 years related professional/business experience in a technical/financial healthcare environment required.

Demonstrated experience in utilization of patient accounting systems.

Knowledge, Skills, Abilities:

Solid computer technical skills required, including proficiency with Microsoft Office products (Word, Excel, Access, and PowerPoint). Epic knowledge preferred.

Proven excellent communication and customer service skills, including the ability to progressively investigate, analyze and identify sources of problems, provide practical solutions, and negotiate resolutions.

Ability to make independent business decisions, considering both the impact on client satisfaction and overall fiscal impact for the department and organization.

Ability to streamline processes for efficiency. Strong analytical aptitude and experience creating financial analysis. Possesses a good sense of general business acumen.

Strong understanding of charging, billing best practices, DRG and CPT/HCPC Medical Coding and Medical Terminology.

Basic understanding of Accounting Principles and Hospital Financial Reporting.

Knowledge of Medicare, Medicaid, and other private payer billing regulations.

License/Certification/Registration:

Certification as a medical coder through AHIMA (CCS, CCS P) or through AAPC (CPC-H) and/or certification as a Revenue Cycle Integrity Professional (CRIP) preferred.

SUPERVISION RECEIVED

Receives primary supervision from the Revenue Integrity Program Supervisor under the leadership of Director of Revenue Integrity & Reimbursement Strategy.

SUPERVISION GIVEN

None

LEVEL OF PHYSICAL DEMANDS

Sedentary: Exerts up to ten pounds of force occasionally and/or a negligible amount of force frequently

WORKING CONDITIONS

Hybrid remote schedule, as determined by departmental needs.

ESSENTIAL FUNCTIONS

Responsible for managing, coordinating, and implementing Charge Description Master (CDM) initiatives and processes to ensure revenue management and protection.

Works with Clinical Charging Departments to support ongoing coordinated consistency of the charge master, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.

Serves as the principal contact for Clinical Charging Departments to ensure revenue integrity best practice solutions.

Oversees charge integrity at the Clinical Charging Department level by ensuring revenue routes to correct cost center, audits for missing and late charges.

Reports Epic charge-related issues for resolution.

Identify internal data standardization opportunities for best practice charging workflows.

Identify and suggest best practice workflows to reduce front-end avoidable denials. Inform those departments as applicable.

Participates in monthly meetings with Clinical Charging Departments to ensure accurate charge documentation, capture and workflow processes are in place. Identifies weaknesses in these processes and quantifies net revenue opportunities of such weaknesses.

Responsible for final review and approval of CDM changes before processing into the EAP. Confirms charge appropriately represents clinical services or procedure prior to creation for billing use. Ensures maintenance and reconciliation of CDM updates.

Daily review of all accounts, claim edit, charge review and charge router review work queues assigned to Revenue Integrity. Reviews the documentation in the medical record for appropriateness to support charges and are aligned with CPT correct coding initiative rules.

Works with Clinical Charging Departments and Revenue Cycle Teams to collect, monitor, analyze data and report findings to drive best practice throughout the revenue cycle.

Administrator for various Revenue Integrity websites and tools.

Perform other duties as assigned.

Why Mount Nittany Health?
At Mount Nittany Health, we provide high-quality patient care with a unique combination of the latest in clinical technology and compassionate medical professionals. We are committed to improving both the quality and availability of healthcare in our region and seek to hire only the best to support the communities we serve.