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LCMC Health · 1 day ago

Charge Review Analyst - Revenue Integrity - Full Time

LCMC Health Corporate

Full-time

Onsite

Mid Level

3+ years exp

LCMC Health is a community-focused healthcare organization dedicated to providing exceptional care in Louisiana. The Charge Review Analyst will collaborate with various departments to ensure accurate charge capture and compliance, conduct reviews of patient charges, and provide training and support on charge-related inquiries.

Health CareHealth DiagnosticsHospitalMedical

Responsibilities

Collaborate with Charge review Coordinators and Charge Review Specialist to monitor charge capture functions across all LCMC entities

Conducts thorough reviews of patient charges to ensure services provided are accurately captured and billed

Verify the correct usage of procedure codes (CPT/HCPCS) and diagnosis codes (ICD-10) to ensure charges align with clinical documentation

Identify and investigate charge discrepancies, missing charges, or incorrect coding, and work with relevant departments to resolve issues

Serve as a resource for charge integrity specialists and departments on charge-related inquiries, providing support and guidance on proper charge capture practices

Provide feedback and training to clinical departments on charge capture issues and regulatory changes that impact billing and coding with oversite by the charge review coordinator

Educate on best practices for documentation and charge entry to enhance revenue capture and compliance

Prepare and present reports on charge review findings, highlighting areas of improvement and compliance risks

Monitor key performance indicators (KPIs) related to charge capture accuracy and timeliness. Create action plans when KPI’s are above target

Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements

Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes

Monitors EPIC Revenue Integrity Dashboard(s) and Ri assigned work queues to assist in completion and timeliness of completion meeting Revenue Integrity Department standards

Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity

Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, charge capture navigators, and other charge components

Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications

Train and assist in daily resolution of revenue integrity edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation

Performs miscellaneous duties as assigned

Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes

Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders

Excellent organizational and project management skills

Strong time management, attention to detail, and follow through

Well-developed research skills

Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively

Work effectively as a team contributor on all assignments

Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations

Delivers positive patient experience, where applicable

Qualification

Revenue cycle processesCPT/HCPCS codingICD-10 codingEPIC HB/PB experienceCharge Description Master (CDM)Managed care contractsAnalytical skillsMS Office proficiencyInterpersonal skillsOrganizational skillsCritical thinkingCommunication skills

Required

3 years' experience in the hospital setting, healthcare industry, revenue cycle or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management

High school diploma or GED with equivalent combination of certification and experience is required

Applicable professional certification through AHIMA (RHIA, RHIT, CCS), RN, LPN or AAPC (COC, CPC) or Epic Certified

Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500

Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10

Advanced knowledge of NCCI edits, and Medicare LCD/NCDs

Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care

Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations

Strong interpersonal and communication skills, well-developed analytic and organizational skills, critical-thinking and the ability to meet deadlines while influencing, but not directly managing the work of others

Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet