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Shriners Children's · 22 hours ago

Revenue Integrity Analyst

United States

Full-time

Remote

Entry, Mid Level

1+ years exp

Shriners Children’s is an organization that respects, supports, and values each other. The Revenue Integrity Analyst ensures that all items and services charged through the Charge Description Master are described, coded, and priced appropriately, while also educating staff on regulatory changes and collaborating on process improvements.

Child CareHealth CareHealth DiagnosticsMedicalNon Profit

Responsibilities

Conduct charge capture assessment activities including, interviews, research and outcomes analysis

Provide analysis, well-supported documentation and recommendations for changes, additions and/or corrections to the CDM according to best practice and company standards

Maintain continuous communication with the revenue departments and provides Revenue Integrity management with information relating to operational opportunities

Collaborate with department managers and staff to review documentation supporting charge capture

Identify areas of deficiency and work with department managers to develop process improvement programs to support compliant billing

At the request of clinical department managers, attend staff meetings to present identified problems and solutions related to charge capture and reconciliation

Support new service addition request process

Assist in defining and assures compliance with the requirements for standardized charge capture workflows

Assist with the monitoring of the SHC Corporate system – wide CDM to ensure that the coding of new and existing charge codes is within applicable coding and billing guidelines

Perform technical review to ensure accuracy, validity, appropriateness, and completeness of CDM

Research CDM and patient charge issues and inquiries

Document and implement a periodic review schedule in conjunction with the charge integrity analysts to confirm that the CDM accurately reflects all services being rendered

Document all changes and/or revisions to CDM by using appropriate software programs

Participate in the implementation and audit processes to ensure that charges are applied uniformly to all patient services at a physical location, regardless of payer

Perform audits with a focus on revenue cycle integrity, assist in the development and implementation of charge practices

Work with Revenue Integrity leadership and department/clinical managers to develop ongoing education programs on charge capture, entry process, reconciliation, rejections, and other charge related processes for departmental leaders and staff members

Assist in developing and executing educational programs, training literature, in-services, and workshops under the direction of the department managers

Confirm that education programs are implemented, and all participants successfully pass the programs

Serve as the primary operational point of contact for Revenue Integrity with other departments regarding charge transactions

Develop and maintain current database of industry-wide data to be used in benchmarking exercises and make information available to all staff

Assess the accuracy of charging vehicles

Work with IS to determine updates required in the software system to ensure appropriate and compliant charges

Test all implemented changes through bill from generation to confirm that bill forms accurately reflect the services being rendered and comply with regulatory and payor requirements

Assist in identifying, defining and functioning within SHC proprietary software processes; review and/or development of reports and audit tools to support the requirements for revenue integrity and outcomes measurement

Compile statistically related data, construct reports and trend information of late entry, missing, inappropriate, or other matters related to charges

Effectively and professionally communicates results, challenges and solutions through daily interaction, regular reports and monthly status meetings with Manager of Revenue Integrity Analysts

Develop and deliver organized, concise yet thorough reporting and communications to management, Sr. Leadership, and other departments regarding proposed, deficiencies, developments and opportunities affecting the Organization regarding charge capture

Assist the department, work unit and/or fellow staff members by covering for absences, training activities, etc

Participate in departmental projects and offers input for the continuous improvement of organizational practices

Prioritizes and manages multiple tasks simultaneously to effectively anticipate and respond to issues as needed in a dynamic work environment

Perform other work-related duties as assigned or requested

Qualification

CDM activitiesCPT coding principlesEpic EMRUB-04 claim formHCFA-1500Charge development processAnalytical skillsCommunication skillsProblem-solving skillsTeam collaborationTime management

Required

1-3 years of experience performing CDM related activities

Experience with CPT-based coding principles from both an inpatient and outpatient reimbursement perspective

Experience with UB-04, MA claim form, and the HCFA-1500, charge development process and the interrelationship of cost accounting, cost management, and related functions, charging processes and compliance issues

Associate's Degree in business/accounting/finance or healthcare business administration - or combination education and experience considered in lieu of degree

Epic EMR required