Rush University Medical Center · 21 hours ago
Sr Revenue Integrity Regulatory & Systems Analyst-24032
Chicago, IL
Full-time
Onsite
Senior Level
$38.02/hr - $61.88/hr
5+ years expRush University Medical Center is seeking a Senior Revenue Integrity Regulatory & Systems Analyst to help translate complex healthcare regulations into accurate, compliant, and optimized charge capture across the organization. This role involves leveraging expertise in coding, CDM, auditing, and Epic systems to identify missed revenue opportunities and drive automation and process improvements while collaborating with compliance and operational teams.
Clinical TrialsEducationHealth CareMedicalTraining
Responsibilities
Apply advanced understanding of regulations, NCD’s. LCD’s and payor concepts, along with revenue integrity concepts to make new and existing regulations actionable within the CDM, charge capture, data, and technology space
Serve as a liaison with compliance to promote and optimize accuracy
Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement
Proactively assess systems, processes, and audit revenue integrity output for accuracy and implements process improvement initiatives
Coordinate and apply regulatory knowledge for Epic optimization and Epic WQ and Charge Router automation recommendations
Monitor Epic Revenue Integrity build to ensure alignment with regulations and charging rules
Harness the Epic and industry best-practices promote accurate automation to reduce manual labor
Use logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines and then propose automation, when applicable
Analyze revenue integrity denial trends and then provide actionable preventative measures for the Epic build
Manipulate data along with identifying and translating trends into actionable remedies
Responsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner
Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing
Audit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits
Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts
Identify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges
Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts
Meets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager
Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement
Engages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned
Qualification
Required
Associates degree or higher with a minimum 5+ years of healthcare experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of healthcare experience working with billing, charge entry, charge capture, or CDM
AAPC or AHIMA certification
Epic HB Certification within 6 months
Proficient and functional knowledge of reviewing charges in the Epic EHR
Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiers
Excellent written and oral communication skills along with problem-solving
Proficiency with MS Office Suite
High degree of accuracy and ability to collaborate with others
Preferred
Epic Hospital Billing (HB) certification
Company
Rush University Medical Center
Rush University Medical Center offers healthcare services for children and adults, clinical trials, medical education and training services.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Parkinson's Foundation
2023-07-25Grant
Leadership Team
Richa Gupta
Chief Operating Officer, Rush University Medical Group
Courtney Cole Kammer
Senior Vice President, Chief Human Resources Officer
Recent News
GlobeNewswire
2026-01-02
Company data provided by crunchbase