Medical Records Analyst

Description We're seeking a detail-oriented Revenue Integrity Coding Analyst to help healthcare organizations maximize their revenue potential while ensuring compliance with industry standards. In this pivotal role, you'll dive deep into coding practices, billing data, and documentation to uncover discrepancies and inefficiencies. Your insights will drive meaningful improvements and optimize revenue capture. Directly reports to Controller.

Job Summary: The Revenue Integrity Coding Analyst is responsible for reviewing, analyzing, and ensuring the accuracy of coding, billing, and revenue processes. This position works closely with the coding, billing, and compliance teams to improve the accuracy of revenue capture and mitigate potential compliance risks. The role involves auditing, monitoring charge capture, and analyzing revenue trends to improve the organization's financial performance.

1. Coding Accuracy and Compliance:
2. • Perform thorough reviews of medical coding for compliance with coding standards (ICD-10, CPT, HCPCS).
   • Ensure coding and billing are accurate, compliant, and align with payer requirements and regulatory guidelines.
3. Revenue Integrity Audits and Analysis:

• Perform retrospective and concurrent reviews of claims for appropriate coding and charge capture.
• Identify missed revenue opportunities and root causes for discrepancies in coding and billing.
• Collaborate with clinical staff to ensure accurate charge capture and compliance with coding standards.
• Analyze trends in charge capture errors and implement solutions to minimize revenue leakage.

1. Data Reporting and Analytics:

• Compile and analyze reports on revenue trends, coding variances, and compliance issues.
• Utilize reporting tools to monitor coding accuracy and identify trends that impact revenue and compliance.
• Prepare detailed audit reports and present findings and recommendations to leadership.

1. Education and Training:

• Provide training and education to coders, clinical staff, and providers on correct coding practices, documentation standards, and billing compliance.

1. • Stay updated on coding regulations, payer policies, and industry standards, and communicate changes to the team.
   • Develop training materials and sessions on revenue integrity processes and coding best practices.
2. Collaboration and Communication:

• Work closely with the revenue cycle team, clinical staff, and coding teams to resolve discrepancies and optimize revenue processes.
• Communicate effectively with providers and clinical leaders regarding coding guidelines and documentation standards.

1. Documentation and Process Improvement:

• Identify gaps in documentation that lead to revenue loss or compliance risks.
• Recommend and implement process improvements to enhance revenue integrity, reduce errors, and improve compliance with regulations.

Required Skills and Qualifications:

• Education:
• High school diploma or equivalent required; Associate or Bachelor's degree in Health Information Management, Healthcare Administration, or a related field preferred.
• Certification in Coding (CPC, CCS, or equivalent) required.
• Experience:
• 2 years of experience in medical coding, billing, or auditing in a healthcare setting.
• Experience with coding standards, including ICD-10, CPT, and HCPCS.
• Experience with EHR systems and revenue cycle management tools is preferred.
• Skills and Abilities:
• Strong knowledge of coding and billing guidelines and regulations (CMS, HIPAA, etc.).
• Excellent analytical skills and attention to detail.
• Proficiency with data reporting and analysis tools (Excel, reporting software, etc.).
• Ability to communicate effectively with clinical and administrative staff.
• Ability to work independently and as part of a team to resolve issues and optimize processes.
FUNCTIONAL DEMANDSFunctional Job Requirements : Job requirements include, but are not limited to: sitting, standing, walking, kneeling, bending, squatting and reaching. Requires good finger dexterity, repetitive motions with hands and fingers. Requires ability to have good vision and hearing. Pushing and pulling equipment may be necessary. Lifting Requirements Job requires light lifting on an occasional basis. Reasonable Accommodations Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising the job duties. Uvalde Memorial Hospital