Weiss Memorial Hospital has been serving Chicago’s North Side and surrounding communities providing excellent health care services for over 60 years. We are a 236-bed, Joint Commission-accredited facility providing a full range of health care services to meet the needs of our diverse community. We have grown to better serve our community to include more than 450 doctors representing 42 medical specialties and more than 800 employees, all committed to providing you with personalized care. We are looking for exceptional people who share our mission and values to join our team!

JOB SUMMARY

The Revenue Integrity Analyst uses advanced knowledge of coding, CDM, charge capture, and auditing to solve complex charging scenarios, provide education and assistance to operational departments, support fellow team members, and develop processes/procedures to ensure accurate and timely capture of all chargeable procedures. The Revenue Integrity Analyst also provides high-level professional support in working advanced outpatient coding edits as well as auditing charges for service lines with potential missed revenue opportunities. This position is also responsible for developing, creating and issuing reports and dashboards within all areas of Revenue Management.

JOB QUALIFICATIONS

· Bachelor’s degree preferred

· Minimum 2-4 years of healthcare experience working with billing, charge entry, charge capture, or CDM.

· Proficient and functional knowledge of reviewing clinical charges.

· 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.

· Analytical Reporting experience required.

SUPERVISION

Exercised: None. Advises the patient care team in facilitating the discharge

Received: Reports to the CFO.

JOB RELATIONSHIPS (INTERNAL/EXTERNAL)

Interacts with patients, visitors and representatives from external organizations. Adjusts patient interaction and to match each patient’s age specific developmental, educational, or other related needs.

JOB DUTIES (* denotes “essential function”)

· Use logic-based critical thinking and decision making to accurately enter/review charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines

· 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.

· Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement.

· Provides input and implements process improvement initiatives recognizing revenue enhancement and charge integrity opportunities.

· Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement.

Weiss Memorial Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.