Revenue Integrity Analyst Sr

Department

Revenue Cycle
Job Summary

This position partners with various departmental staff and physicians: Patient Financial Services (PFS), Case Management (ICM), Health Information Management (HIM), Corporate Compliance, Surgery, Nursing, Physicians, Outpatient Procedural Departments, Reimbursement, and Internal Audit. Serves as a primary resource and educator to these departments for appropriate patient status, charge capture, coding, billing, medical necessity, Medicare rules, and payment methodologies. Leads and participates in various Revenue Cycle committees, appeals processes, and contributes to changes which improve overall compliance and improve revenue recognition. The primary goal of this position is to improve the performance of the Revenue Cycle processes including developing best practices, clinical documentation, coordinating issue resolution, and establishing proactive prevention measures. This position provides excellent customer service and has a high degree of autonomy.

Required Qualifications

- Require coding certification from the American Health Information Management Association or American Academy of Professional Coders within one (1) year of hire date.
- Require a minimum of three (3) years of strong training and background in coding and reimbursement.
- Require demonstrated knowledge of Medicare, Medicaid, Medicare OPPS reimbursement and third party billing rules and coverage.
- Require demonstrated knowledge of medical necessity rules and Medicare inpatient only list.

Preferred Qualifications

- Prefer previous auditing experience.
- Prefer demonstrated proficiency in verbal and written communication.
- Prefer demonstrated ability to relate well to others in a variety of functional areas, handle multiple responsibilities simultaneously and to problem-solve and think both creatively and analytically.

Mandatory Education

BD: Bachelor Degree

Preferred Education

MBA: Master of Business Admin

Sarasota Memorial Hospital was recently recognized again by ranking #1 Hospital in the Region by the U.S. News's Best Hospital report by scoring a Perfect 10!   Not only that, but SMH was also designated at a national "standout" hospital for earning top ratings in all evaluated conditions and procedures - an accomplishment achieved by less than 1% of the 4000+ hospitals.  Our system has also earned Magnet® recognition from the American Nurses Credentialing Center (ANCC), as well as these additional accolades: Gallup Great Workplace 2018; recipient of an "A" grade for Patient Safety. Sarasota Memorial Hospital is Magnet designated and the only provider of Level II trauma services, obstetrical services, and Level III neonatal intensive care in Sarasota County.

Reputation. Community. Impact. Growth.

Every day, our patients at Sarasota Memorial Health Care System receive a first-class experience in care from a team on a mission to deliver the highest level of care in America.  In the process of rising to that challenge, one by one, our people are finding their purpose and feeling their impact.  Now it is your turn to see yourself here.

Recognition:

* 5- Star Quality Rating- SMH- Sarasota is the only hospital in Florida to earn the federal Centers for Medicare & Medicaid Services' highest rating every year since its inception.

* 50 Best Hospitals- SMH ranked among U.S. News & World Report's 50 Best Hospitals in two specialties, Rehabilitation and Obstetrics/Gynecology in 2023-2024, and among the nation's top 10% high performers in 18 other medical specialties, procedures and conditions.

* World's Best Hospitals- SMH- Sarasota has made Newsweek's prestigious list six years in a row, since the global rankings began in 2019.

* "A" for Patient Safety- SMH- Sarasota has earned straight A's since it began participating in the Leapfrog Group's hospital safety survey in 2016. 

* Magnet Hospital- SMH has been recognized as a Magnet hospital for the past 20 years by the American Nurses Credentialing Center, a continuous achievement for nursing excellence shared by less than 1% of hospitals nationwide. 

* America's Best Employer/Workplace- SMH topped Forbe's list of America's Best Employers, ranking among the top 20% of large employers across all industries in 2024, and #1 healthcare employer in Florida in 2023. The health system also earned a 5-star rating in Newsweek's 2024 list of "America's Greatest Workplaces for Women." 

The benefits of being the best:

Our commitment to becoming the best community hospital and health care system means providing the best possible benefits to our people. Some highlights:

Total Rewards Package

• Paid Time Off (start earning PTO on day one of employment)
• Tuition Reimbursement
• Discounted Medical, Prescription, Dental, Vision Benefit Plans for Full & Part-Time Employees
• Flexible Spending Accounts (Health Care and Dependent Care) - Pre-Tax Dollars
• Life Insurance
• Competitive rates 
• Bonuses offered 
• Disability Insurance
• Retirement Savings Plan: 403b
• Sarasota Campus for now - Discounted Child Care & Before and After School Program and Summer Camp!
• Bereavement Leave
• Free Parking
• On Campus Dining w/ a 10% discount
• Credit Union w/ teller machines on campus
• Direct Deposit
• Free Wellness Screening
• Free confidential counseling services
• Employee Discount Programs
• Recognition Programs
• Referral Programs
• Tremendous growth opportunities for hard workers!

Employment Screening Requirements

As part of Sarasota Memorial Health Care System’s commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/