What are the responsibilities and job description for the Revenue Integrity Analyst position at the Chickasaw Nation?
We are currently looking for a Full Time Revenue Integrity Analyst to join our Health Revenue Data Analytics Team team located at the Apila Center working 8:00AM-5:00PM - Mo Tu We Th Fr.
Summary:
The purpose of this position is to perform and review regular claim audits to support the maintenance and enhancement of charge capture and overall billing functions. In addition, this position will capture workflow enhancements, consistent charge structure and rate setting according to industry standards and payer contracts, denial and underpayment trends, and the overall efficiency of the revenue cycle process.
Responsibilities:
- Coordinates hospital charge audit processes by monitoring and reporting revenue metrics and charge capture data further analyzing audit findings for process improvement opportunities
- Reviews billing and registration workflows and works with the appropriate team to adjust systems to better catch errors and or omissions
- Assist with CDM changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable charging and billing guidelines
- Collaborates with revenue integrity leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement; may coordinate revenue staff training
- Conducts routine audits of claims ensuring accurate and timely payments from third party payers in compliance with managed care contracts and government fee schedules
- Arranges audit timelines with individual departments and external business partners and ensures each party meets set deadlines
- Participates in chargemaster (CDM) maintenance efforts by reviewing whether charges accurately reflect provided services/supplies and are consistent with industry best practices
- Summarizes hospital audit findings to leadership and/or the compliance in efforts to ensure all charges are properly captured and reimbursed
- May visit revenue generating departments and conduct charge audits to gauge the efficacy of charge capture and other process flow recommendations
- Provides first class customer service - courteous and helpful to all internal and external customer types
- Answers questions in a courteous and professional manner
- Greets and engages with a smile
- Determines needs, seeks positive experience and outcomes
- Completes all training and development requirements and participates in continuing education opportunities
- Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
- Maintains general upkeep of work area and maintains a safe environment
- Maintains and promotes professionalism
- Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
- Adheres to Chickasaw Nation dress code standards
- Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
- Performs all other duties as assigned
Competencies:
Essential:
Essential:
- Ability to prepare clear and concise role-specific reports
- Ability to work effectively in a stressful environment or situation
- Able to follow instructions, both written and oral
- Able to adhere to all scheduling and attendance requirements
- Must be detail-oriented
- Ability to work independently
- Honesty, truthfulness, reliability, accountability
- Able to read, understand, apply, and retain knowledge of Chickasaw Nation, departmental, divisional and all other rules, regulations, policies, procedures and guidelines
- Thorough understanding of revenue integrity processes and their impact throughout the revenue cycle
- Must be proficient in the use of electronic health record keeping systems
- Works well within a team
- Able to verbally communicate in a professional and positive manner with other team members, departments, guests and management
Skills:
Essential:
Essential:
- Basic Computer skills
- Intermediate skill using Excel for multiple purposes
- Intermediate skill in creating PowerPoint presentations
- Intermediate skill using Word for multiple purposes
Experience:
Essential:
Essential:
- 3 years directly related experience
Education:
Essential:
Nonessential:
Nonessential:
Essential:
- High School, GED or Equivalent
Nonessential:
- Bachelors Degree in directly related field
Nonessential:
- Bachelor's degree in health information management, business, or finance is preferred
Credentials:
Essential:
Essential:
- Pass general background check
Working Conditions:
Essential:
Essential:
- Works in a hospital or clinic environment
- Works in an office setting
- Sitting up to 50% of shift
- Frequently bend, kneel, stoop, push, reach
- Sometimes lift and or carry up to 25 lbs
- Pass pre-employment drug test
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