Category:

Admin Support

City:

Jackson

State:

Tennessee

Shift:

8 - Day (United States of America)

Job Description Summary:

The Revenue Integrity (RI) Analyst works collaboratively in a team environment providing support to the Revenue Integrity team. The role uses reporting tools, data extraction and analysis to understand revenue and compliance risks and opportunities with significant impact to the health system and conveys these risks to leadership. Monitors Revenue Integrity specific work queues, including Revenue Guardian edits, charge reviews, and charge router review work queues, among other duties. Supports Revenue Integrity related troubleshooting needs and disseminates leading practice and lessons learned across service line teams. Actively communicates and presents pertinent information as well as receives direction from and reports to the Revenue Integrity Manager.

ESSENTIAL JOB FUNCTIONS:

Accountable for daily reviews of RI work queues based on assigned service line or review group, including charge reviews and do not bill (DNB) edits assigned to RI and exception-based RI owned Epic work queues (e.g., Revenue Guardian, Charge Review, and Charge Router)Aggregates annual work queue and revenue/volume performance across services lines by facility for the RI Manager to identify focused areas for their account reviews and risk assignmentAnalyzes details of the work queue volume around charge assignments for the RI team to customize their knowledge sharing based on the areas of opportunities and coordination with Information Technology (IT) for additional educational material for clinical end-usersAnalyzes RI specific data from CDM Analysts to share with RI Manager for their detailed reviews of the clinical scenariosServes as the liaison between clinical operations and revenue cycle to support clinical operations in charge capture, reconciliation, and revenue monitoring activitiesCollaborates with various stakeholders to identify charge capture root cause and implement remediation plansConducts compliance and quality audit reviews, maintains industry KPI awareness, conducts ongoing charge capture risk assessment as well as the quality, integrity, consistency and comprehensiveness of clinical department exception-based revenue guardian work queuesDevelops and updates any RI related job aides and work queue guides and coordinates with IT and other stakeholders, where applicable.Implements revenue leakage improvements through informatics clinical workflow and IT application optimizations and identifies process improvement initiatives and imperativesKeeps up-to-date on coding and regulatory guidelines to guide their charge validation processesMonitors, controls, audits, and analyzes clinical data; validates by researching anomalies and cross-referencing with other systems from revenue cycle teams to share with RI Manager for detailed reviews of scenariosObtains data extracts from specific systems to support RI assessments and root cause analysis; validates data by researching anomalies and cross-referencing data with other systemsOversees clinical department charge capture process, and escalates charge capture issues and revenue leakage risksPerforms data analysis and drilldown reporting, maintains reports and dashboards, and identifies trends for RI teams by service line in order to accomplish department/service line goals and objectives. Also performs other duties as assigned, volunteers for team assignments, and actively participates in team projects and implementing changesPrepares data for RI focused quality assurance reviews and data collectionTracks and reports trends of high volume, high dollar, and high billing edits to drive business decisions and escalate when applicableWorks with the RI Manager and CDM team to optimize work queue logic as well as schedules and runs monthly service line reviews of work queues with the RI teams and escalates issues or questions to the specific RI team responsible for the area under reviewPerforms related responsibilities as required or directed.

JOB SPECIFICATIONS:

EDUCATION:

Associates or Bachelor’s Degree in Business, Accounting, Finance, Health Administration, or another related field

LICENSURE, REGISTRATION, CERTIFICATION:

Preferred Certified Outpatient Coder (COC), Certified Professional Coder (CPC), Certified Healthcare Financial Professional (CHFP) or Certified Revenue Cycle Representative (CRCR)

EXPERIENCE:

Two to three years of experience as an analyst in hospital revenue integrity, decision support, business intelligence applications, visualization engines and database management. Epic experience preferred

KNOWLEDGE, SKILLS AND ABILITIES:

Proficient in Microsoft Office Suite and Windows; especially Excel, Access, Word and    PowerPointWilling to travel up to 10% as neededAbility to synthesize and communicate complex and diverse informationAbility to be self-directed and work with minimal supervision/oversight

NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.