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Beth Israel Lahey Health · 2 weeks ago

Revenue Integrity Senior Analyst - HMFP

Woburn, MA

Full-time

Onsite

Mid, Senior Level

$55K/yr - $74K/yr

5+ years exp

Beth Israel Lahey Health is a growing healthcare organization dedicated to making a difference in people's lives. The Revenue Integrity Senior Analyst will contribute to revenue integrity and coding oversight, leading process improvements and ensuring adherence to standards and policies within the organization.

Elder CareHealth CareHospitalPrimary and Urgent CareProfessional ServicesTraining

Responsibilities

Monitor departments’ adherence to professional charge reconciliation, work-queue, and professional coding quality expectations and support departments with education, process improvement, and follow-up

Conduct periodic departmental reviews of professional charge reconciliation processes to ensure adherence to policies and confirm all professional charges are captured and reported accurately

Review and document changes within the charge description master (CDM) and fee schedule(s) and ensure these changes are implemented within appropriate systems. Route for approval according to HMFP’s established policies and procedures

Lead annual, quarterly, and regular CDM and fee schedule maintenance activities

Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement

Support departments with analyzing services for coverage and reimbursement

Work with HMFP departments to identify revenue management opportunities, staying current with government and commercial payer’s billing and coding requirements

Develop, deliver, and revise revenue integrity and coding education and training programs in coordination with the Director and HMFP Compliance Department

Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate stakeholders and provide any necessary follow-up

Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly

Monitor coder quality audit results and coder productivity. Support departments by establishing audit processes, education and training, process improvement, and follow-up

Lead assigned revenue integrity and coding projects, committees, and meetings

Develop and execute tools and processes to identify potential areas of delayed or lost revenue. Collaborate with departments on process improvement and necessary follow-up

Build strong relationships and facilitate effective communication between key stakeholders. Collaborate with others to develop and implement action plans to resolve revenue integrity and coding issues

Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken for the Director and other stakeholders

Qualification

Certified Professional Coder (CPC)Revenue cycle processesCoding complianceEPIC PB experienceCPT codingHCPCS codingICD-10 codingCharge reconciliationCharge auditingAnalytical skillsMicrosoft OfficeCommunicationProblem-solving skillsOrganizational skillsPresentation skillsAttention to detailTeam collaboration

Required

Bachelor's degree required

Certification: Certified Professional Coder (CPC) required

5 or more years physician/professional revenue operations experience with a focus in one or more of the following areas: coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, CDM management

Extensive knowledge of: revenue cycle processes and physician billing

Extensive knowledge of: code sets to include Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS), and International Classification of Diseases (ICD-10)

Extensive knowledge of: reimbursement theories to include RBRVUS, MPFS, and managed care

Extensive knowledge of: NCCI edits and Medicare LCD/NCDs

Extensive knowledge of: health care documentation, coding and billing requirements as well as federal and state health care regulatory requirements

Extensive knowledge of: health care compliance

Extensive knowledge of: medical terminology, anatomy and physiology along with clinical department activities

Abilities: Manage large complex projects assignments, investigate, analyze and resolve issues at a high level

Excellent communication, presentation, organizational, analytical and problem-solving skills. Must communicate effectively with physicians, leadership, and other billing personnel

Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team based environment

Advanced skills with Microsoft Office, including Outlook, Word, Excel, PowerPoint, Power BI and other web-based applications. Ability to produce complex documents

Strong analytical ability. Skills to collect, organize and analyze data, produce actionable reports, and recommend improvements and solutions