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Gundersen Health System · 7 hours ago

Revenue Integrity Analyst

Wisconsin, United States

Full-time

Hybrid

Mid Level

4+ years exp

Gundersen Health System, through Emplify Health, is seeking three Revenue Integrity Analysts to enhance revenue cycle performance. The analysts will be responsible for charge reconciliation, collaborating with clinical leadership and revenue cycle staff, and ensuring compliance with billing policies.

Health CareHospitalMedicalNon Profit

Responsibilities

Researches and analyzes both professional (PB) and Facility (HB) claims prior to new clinical services being added to ensure the appropriate reimbursement of claims. This includes all payors; to see that government regulated billing rules and payer policies are being reinforced

Collaborates with Clinical Operation Directors and Clinical leaders to perform charge reconciliation to ensure performed visits, procedures, and tests are appropriately billed

Collaborates with Clinical Operation Directors and Clinical leaders to create mitigation plans for charges that are not entered in a timely fashion to ensure we are not at risk for revenue loss

Interprets existing revenue cycle policies and operating practices to make recommendations for improvement

Demonstrates in depth knowledge and technical expertise in CPT, HCPCS, ICD-10, as well as current payer policies for coding, billing and claims processing, and provider-based billing rules

Serves as the point of contact for complicated billing scenarios to establish proper process(es) to get the claim filed

Facilitate multi-department billing steering committee

Oversees and helps maintain the Revenue Guardian Edits in Epic

Reviews Epic Dashboards to ensure all charges are captured in a timely manner, are in compliance with state and Federal guidelines and are achieved within expected window after patient discharge

Identifies and works with Information Systems to rectify any claims data transmissions issues as they arise and track any changes

Creates, generates, and maintains ad hoc reports proactively and as requested on various transactions to ensure consistency on claims submissions and to direct chargemaster analyst as needed to update clinical charge capture in Epic

Maintains extensive knowledge of current EHR technical and professional billing software modules and how it relates to all payer processes

Collaborates closely with all Revenue Cycle leaders on processes, procedures, and defining improved workflows for billing and reimbursement practices and appropriate claims submission

Collaborates with Compliance on governmental regulated billing rules and policies to ensure new services are set up appropriately

Qualification

CPT codingHCPCS codingICD-10 codingHealthcare billing systemsAnalytical thinkingCommunication skillsProblem-solvingReport generationEHR software knowledgeAttention to detailAdaptabilityCollaboration

Required

Bachelor's degree in Business, Healthcare Administration, Finance, or related field

Minimum 4 years in healthcare plus experience with clinic/hospital billing systems

Certification from a recognized professional coding or health information organization, such as AAPC or AHIMA

Ability to interpret complex data and provide actionable insights

Strong verbal and written communication skills; comfortable presenting to executive leadership

Thrives in a dynamic environment with evolving regulations and priorities

Proactively identifies issues and develops innovative solutions

Ensures accuracy in charge capture, compliance, and financial reporting

Benefits

In addition to medical and dental, we have pet insurance and a substantial contribution to retirement

24/7 Employee Assistance Program for employees and their families, generous PTO and paid holidays

Tuition Invest Program totaling up to $3k per year, access to a catalogue of hundreds of internal courses, corporate incubator, Career Development Center

12 months of Celebration to include monthly educational events