Description

At Bristol Health, we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents and families. We are committed to provide compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect and Empathy (C.A.R.E.). We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. Use your expertise, compassion, and kindness to transform the patient experience. Make a difference. Make Bristol Health your choice.

JOB SUMMARY:

Function: Under the direction of the Revenue Integrity Manager, the Revenue Integrity Analyst assists with the strategy for maximizing gross and net revenue capture across the Bristol Health enterprise. Primary responsibilities will include Charge Description Master (CDM) maintenance, strategic pricing, payment validation, and payer contract maintenance.

ESSENTIAL JOB FUNCTIONS:

• Evaluate current charging/coding structures in revenue generating departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements
• Monitor changes to coding and billing rules and share findings with appropriate practices and departments. Responds to departmental charging inquiries in a timely manner
• Assess the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents used to capture revenue
• Ensure the Charge Description Master is maintained and changes are made in a timely manner
• Assist with payer reimbursement variance trends
• Coordinate with Leadership, Contract Management and other Revenue Cycle team members to resolve charge discrepancies and payment variance issues
• Assist with revenue improvement opportunities and analysis of financial impact as related to professional and hospital clinical departments
• Other duties as assigned

KNOWLEDGE / SKILLS / ABILITIES:

• Ability to understand and interpret statistical reports
• Excellent understanding of multiple clinical disciplines and charging practices
• Knowledge and understanding of insurance claim processing and third-party reimbursement
• Knowledge of state and federal regulations as they pertain to billing processes and procedures
• Knowledge of healthcare related financial and/or accounting practices
• Skill in effective oral, written, and interpersonal communication
• Experience in leading projects and independent work efforts
• Skill in problem-solving in a variety of settings and translation of data into actionable steps
• Ability to read, understand and interpret, analyze, and apply complex regulatory requirements
• Ability to work independently and take initiative

Qualifications

REQUIRED EDUCATION / EXPERIENCE:

• Three (3) to five (5) years’ experience in revenue cycle processes and billing practices
• Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10
• Coding certificate or experience preferred
• Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
• Associate or bachelor’s degree in finance or related field. A combination of education and experience acceptable

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.