Hybrid Revenue Integrity Analyst

at Lourdes Health System

• Job title: Revenue Integrity Analyst
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $70,935 - $110,268 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Mount Laurel, United States

About the role

• Revenue Integrity Analyst optimizing Revenue Cycle for Virtua Health. Conducting root cause analytics and audits to identify process improvements and related opportunities.

Responsibilities

• The position is responsible for root cause analytics along with audits to help identify opportunities, issues, and process improvement within the Revenue Cycle.
• This role supports the revenue cycle workflows, charge capture, workqueue and denial review processes within an Epic based EMR.
• This position will help optimize Revenue Cycle by evaluating, validating and trending data for presentation to all levels of the organization.
• Will support the Virtua Hospitals, Physician Groups and Home Health.
• Perform quantitative and financial analysis along with audits designed to identify opportunities for improvement across the full spectrum of the Revenue Cycle.
• Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payor needs.
• Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
• Works with revenue producing departments to ensure the ongoing coordinated consistency of the charge master and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Conduct analytical reviews determine net revenue effect of proposed charge master and fee schedule changes.
• Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.
• Incumbent must develop close working relationships with management and staff in Revenue Integrity, Finance, Information Technology and Revenue and Clinical Operations allowing them to perform deep-dive analysis and reviews assisting with the identification of trends, solutions and potential corrective action steps.
• Will work both independently and have a high level of self-directed work efforts as well as be an integral part of the Revenue Integrity Team. Revenue Cycle will include areas from Hospital, Physician and Home Health.
• Monitor and assists with review of revenue cycle workqueues in Epic.
• Perform analysis to identify issues, trending, root cause, and action plan development with workqueue issues.
• Assist in strategic pricing process to optimize reimbursement within budget guidelines.
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations.
• Provide guidance and communication and collaborate with Revenue Integrity Team, Clinical Operations and IT to help ensure workqueue rules are accurate and updated based on annual and quarterly coding changes.
• Assist with Epic performance reporting, including assisting with Revenue & Usage, Enterprise Charge Reconciliation and Volume Reports.
• Workqueue and reporting will include areas from Hospital, Physician and Home Health.
• Serve as resource to Patient Financial Services staff for reporting problems and denials on individual claims.
• Assist in researching coding issues, provide guidance and recommend solution to account representative.
• Analyze billing errors and denial data to identify root cause of issues.
• Work with Revenue Integrity Team, Clinical Operations and Patient Financial Services staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials and accurate and reimbursement.
• Claim issues and denials will include areas from Hospital, Physician and Home Health.
• Lead and participate in projects related to Revenue Cycle initiatives.
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Provide input to Director and Manager for annual Revenue Integrity planning process.
• Assist with additional projects as needed for Hospital, Physician and Home Health.

Requirements

• 3 to 5 years experience within a large hospital or integrated healthcare delivery system
• Ability to work collaboratively across disciplines and business lines
• Exceptional oral/written communication skills and highly customer-focused
• Excellent interpersonal and presentation skills
• Able to communicate with many, various customers
• Ability to prioritize, plan and execute
• Excellent critical thinking, analytical skills
• Bachelor Degree, in Accounting, Finance, Healthcare preferred
• EPIC Revenue Integrity, Hospital Billing, Physician Billing Certification, preferred

Benefits

• medical/prescription, dental and vision insurance
• health and dependent care flexible spending accounts
• 403(b) (401(k) subject to collective bargaining agreement)
• paid time off
• paid sick leave as provided under state and local paid sick leave laws
• short-term disability and optional long-term disability
• colleague and dependent life insurance and supplemental life and AD&D insurance
• tuition assistance
• employee assistance program that includes free counseling sessions