Date Integrity Analyst - St. Peter's Hospital, Albany NY - FT Days
POSITION PURPOSE
Provides extensive support covering all aspects of registration related billing claims edits (pre A/R) to submit clean claims to the third-party payers. Responsible for analyzing and working reports/edits for review and to correct demographic, insurance, provider, and charge information as required and according to payer guidelines to ensure claims are billed out accurately and processed for payment timely. Works closely with other departments and multiple specialties to obtain required information and for root cause analysis.
ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the mission, vision, and values of Trinity Health in leadership, behaviors, practices, and decisions. Reconciles and corrects Patient Access related held claims and/or follows up on edits by correcting and/or collaborating with various departments to correct for resubmission. Applies updates to all necessary systems to correct accounts and ensure clean processing upon the next billing cycle. Verifies that pre-bill claims are passing internal edits in a timely fashion. Ensures claims are submitted in the proper format as defined by the requirements in the facility’s various Third-Party Payer contracts. May reaches out to a specific payer, provider, or patient to resolve the edit. Follows data entry guidelines by payer type and billing area. Verifies insurance via system, website, or phone. Adds and understands specific data such as modifiers, occurrence codes, value codes, condition codes, payer specific information. Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solution and /or escalating unresolved accounts to Manager. Maintains knowledge of current reimbursement trends and developments in hospital registration and billing. Identifies registration edit issues, data entry problems and/or educational needs and opportunities to reduce denials and increase payment and communicate trends to the Manager. Escalates situations/issues to Manager, as appropriate. Maintains access to, and security of, highly sensitive materials. Promotes confidentiality and uses discretion when handling patient information. Communicates quality and / or compliance issues to management. Meets productivity standards, targets, error ratios and reporting requirements as assigned by the department Manager. Participates in department meetings and training seminars as assigned by the department Manager. Participates in the testing for assigned software applications, including verification of field integrity. Partners with end users to provide education on errors and prevention steps. Other duties as needed and assigned by the manager. Maintains a working level knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Corporate Integrity Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
MINIMUM QUALIFICATIONS
High school graduate. College degree preferred. Minimum of three (3) years of previous patient registration / insurance verification experience in a healthcare environment Previous coding and edit/billing experience strongly preferred. General revenue cycle experience is preferred. Familiarity with EPIC Patient Access work queues. Must have up to date knowledge of third-party rules and regulations. NAHAM CHAA certification and / or HFMA CRCR certification within one (1) year of hire. Proficient in Microsoft Office software. Must be comfortable operating in a collaborative, shared leadership environment. Strong analytic and problem-solving abilities and techniques with attention to detail. Strong problem-solving skills and analytical abilities to resolve routine to moderately complex problems. Well-developed interpersonal, written, verbal, and presentation communication skills to effectively communicate with other departments, vendors and providers.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Communicates frequently, in person and over the phone, with people in all locations on product support issues. Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions. Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities. Must possess the ability to comply with Trinity Health policies and procedures.
All new employees are required to undergo and pass all applicable state and federally mandated pre-employment screening requirements.
Pay Range: $20.20 - $29.30
Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.