Revenue Integrity Analyst

Overview

• Background in revenue cycle management, financial operations, or Clinical Documentation Improvement (CDI)
• Strong analytical skills with the ability to interpret complex data and provide actionable insights
• Comprehensive knowledge of healthcare billing, coding practices, and regulatory compliance standards

This position contributes and supports revenue integrity’s mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. Under the direction of the Director of Revenue Integrity, the Revenue Integrity RN Analyst plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES  

• Interacts with clinical department directors to monitor charge capture functions across all entities.
• Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
• Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities.
• Monitors EPIC Revenue Integrity Dashboard(s)
• Participates in moderately complex projects related to revenue integrity initiatives.
• Provide support for assigned cost centers within service lines
• Participates in analyzing changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Train and assist clinical team with revenue integrity functions.
• Performs miscellaneous duties as assigned.
• Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
• Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders.
• Excellent organizational and project management skills.
• Strong time management, attention to detail, and follow through.
• Well-developed research skills.
• Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
• Work effectively as a team contributor on all assignments.
• Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
• Delivers positive patient experience, where applicable.

EDUCATION & EXPERIENCE  

RN or medical coding background

Experience: In excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; hospital leadership. Clinical leadership experience preferred with high level focus charges/revenue. EPIC HB/PB experience preferred. Knowledge of CPT/HCPCS procedural coding preferred.

Benefits

Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to: 

· Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.

· Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.

· Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.

· Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.

· Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.

· Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.

Salary : $74,569 - $100,000