Spartanburg Regional Healthcare System · 2 months ago
Analyst-Billing Integrity
Spartanburg, SC
Full-time
Hybrid
Mid Level
3+ years expSpartanburg Regional Healthcare System is looking for a Billing Integrity Analyst to ensure compliance with Medicare billing requirements. The role involves auditing processes, communicating changes, and collaborating with the Revenue Cycle team to maintain billing integrity and compliance with regulations.
DeliveryHealth CareHospital
Responsibilities
Working knowledge of all Revenue Cycle-Business Services Department processes and procedures related to Billing compliance, coding edits etc
Research coding, coverage, medical necessity and other compliance issues for all payers related to charging/billing
Monitors WPS/Palmetto GBA and CMS for updates that affect charge capture and billing requirements
Attend educational sessions/seminars directly related to area of responsibility as requested by Director
Prepares and presents reports detailing the routine claim audits/reviews and transaction testing performed to support departmental compliance initiatives
Work Closely with our Revenue Integrity team and Charge Master Analyst regarding new services as it relates to charging/billing
Maintains a high level of involvement in the day-to-day activities related to areas of responsibility
Assists Denials Management team, as requested, on Outpatient appeals such as but not limited to Medical Necessity edits/denials
Must be able to work well with Department managers, Clinical billing staff, departments, and other internal or external customers
Must be able to effectively serve in a lead role with the various teams throughout the health system
Attention to detail, excellent organizational skills
Must be self-directed, motivated and able to work independently
Must be flexible in responsibilities and work schedule
Qualification
Required
Bachelor's Degree
Seven years of relevant experience will be considered in lieu of the education degree requirement
Minimum of three years of experience in Hospital or Professional billing, Medical records or Charge Audit
Demonstrated general knowledge of billing and coding rules and regulations for governmental and managed care payers
Must have excellent communication skills and work well as a member of the Revenue Integrity team
Develop and maintain a tracking system for all reviewed documentation and outcomes
Working knowledge of all Revenue Cycle-Business Services Department processes and procedures related to Billing compliance, coding edits etc
Research coding, coverage, medical necessity and other compliance issues for all payers related to charging/billing
Monitors WPS/Palmetto GBA and CMS for updates that affect charge capture and billing requirements
Attend educational sessions/seminars directly related to area of responsibility as requested by Director
Prepares and presents reports detailing the routine claim audits/reviews and transaction testing performed to support departmental compliance initiatives
Work Closely with our Revenue Integrity team and Charge Master Analyst regarding new services as it relates to charging/billing
Maintains a high level of involvement in the day-to-day activities related to areas of responsibility
Assists Denials Management team, as requested, on Outpatient appeals such as but not limited to Medical Necessity edits/denials
Must be able to work well with Department managers, Clinical billing staff, departments, and other internal or external customers
Must be able to effectively serve in a lead role with the various teams throughout the health system
Attention to detail, excellent organizational skills
Must be self-directed, motivated and able to work independently
Must be flexible in responsibilities and work schedule
Preferred
Bachelor's degree
Manager or Coordinator experience
2+ years' experience with reporting analysis
CPC, RHIT or equivalent coding certification
MS Office experience
Company
Spartanburg Regional Healthcare System
Founded in 1921, Spartanburg Regional Healthcare System (SRHS) offers a full spectrum of services through six hospital campuses: Spartanburg Medical Center, Spartanburg Medical Center — Mary Black Campus, Pelham Medical Center, Cherokee Medical Center, Spartanburg Hospital for Restorative Care and Union Medical Center.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
B
Bruce Davis
EVP, CFO
B
Beth Lawson
Chief Nursing Officer
Recent News
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