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Monument Health · 1 week ago

Revenue Integrity Analyst

Rapid City, SD

Full-time

Onsite

Mid Level

$24.19/hr - $30.24/hr

3+ years exp

Monument Health is a healthcare organization seeking a Revenue Integrity Analyst. The role is responsible for monitoring charge capture, coding, and variances in reimbursement from payers, ensuring compliance and accuracy in claims submission.

Health CareHospitalNon ProfitRehabilitation

Responsibilities

Understands the Revenue Cycle and the responsibility and goals of each area and how they impact the financial wellbeing of the organization

Demonstrates knowledge of compliance standards and payor specific data to properly file claims, ensuring prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients

Demonstrates working knowledge of interfaced, integrated Revenue Cycle software support tools

Verifies all necessary elements in the electronic medical record; appropriate charges for services rendered, accurate coding for services, reason for denials, denial status, and appeal and results of action taken

Performs prospective and retrospective audits, using appropriate tools to detect omissions or errors in charge capture, coding and billing

Verifies accuracy of transactions which appear on the account and communicates errors, omissions and corrections to appropriate caregivers

Understands the basics of outpatient Health Information coding, with emphasis on assigned specialties/departments

Has a working knowledge of the procedures and EHR workflows that are in place to generate charge capture, for assigned departments

Identifies additional or corrected information needed to process a denied claim through communications with the Revenue Cycle team or payor representatives in a timely manner, to expedite payor reimbursement

Works with Revenue Integrity leaders and caregivers to assure accurate and complete Charge Description Masters and Physician Fee Schedules via scheduled review

Provides a detailed and complete report monthly of charge capture audits, denials, appeals, follow-up and results on appealed accounts, root cause analysis of issues responsible for inaccurate charge capture or denied services

Participates in the planning, development, implementation, and maintenance of departmental monitoring tools

Additional duties as assigned