Beth Israel Deaconess Medical Center
Revenue Integrity Senior Analyst - HMFP
Beth Israel Deaconess Medical Center, Woburn, Massachusetts, us, 01813
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Revenue Integrity Senior Analyst - HMFP
role at
Beth Israel Deaconess Medical Center
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Under the direction of the Director, Revenue Integrity and Coding at Harvard Medical Faculty Physicians (HMFP) at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, which aims to maximize synergies across HMFP departments, initiate and lead revenue integrity and coding process improvement, identify and address risks, monitor key revenue integrity and coding operational and financial metrics, provide subject-matter expertise, and ensure adherence to established standards and policies.
Job Description:
Primary Responsibilities
Monitor departments’ adherence to professional charge reconciliation, work-queue, and professional coding quality expectations and support departments with education, process improvement, and follow-up.
Conduct periodic departmental reviews of professional charge reconciliation processes to ensure adherence to policies and confirm all professional charges are captured and reported accurately
Review and document changes within the charge description master (CDM) and fee schedule(s) and ensure these changes are implemented within appropriate systems. Route for approval according to HMFP’s established policies and procedures.
Lead annual, quarterly, and regular CDM and fee schedule maintenance activities.
Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement.
Support departments with analyzing services for coverage and reimbursement.
Work with HMFP departments to identify revenue management opportunities, staying current with government and commercial payer’s billing and coding requirements.
Develop, deliver, and revise revenue integrity and coding education and training programs in coordination with the Director and HMFP Compliance Department.
Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate stakeholders and provide any necessary follow-up.
Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly.
Monitor coder quality audit results and coder productivity. Support departments by establishing audit processes, education and training, process improvement, and follow-up.
Lead assigned revenue integrity and coding projects, committees, and meetings.
Develop and execute tools and processes to identify potential areas of delayed or lost revenue. Collaborate with departments on process improvement and necessary follow-up.
Build strong relationships and facilitate effective communication between key stakeholders. Collaborate with others to develop and implement action plans to resolve revenue integrity and coding issues.
Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken for the Director and other stakeholders.
Required Qualifications
Certification: Certified Professional Coder (CPC) required.
5 or more years of physician/professional revenue operations experience with a focus in one or more of the following areas: coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, and CDM management.
EPIC PB experience preferred.
Extensive knowledge of:
Revenue cycle processes and physician billing
Code sets including CPT, HCPCS, and ICD-10
Reimbursement theories including RBRVUs, MPFS, and managed care
NCCI edits and Medicare LCD/NCDs
Healthcare documentation, coding, and billing requirements, and federal/state regulatory requirements
Medical terminology, anatomy and physiology, and clinical department activities
Abilities:
Manage large complex project assignments, investigate, analyze, and resolve issues at a high level.
Excellent communication, presentation, organizational, analytical, and problem-solving skills. Must communicate effectively with physicians, leadership, and other billing personnel.
Independent problem-solving, strong attention to detail, and ability to work in a fast-paced, collaborative team environment.
Advanced skills with Microsoft Office (Outlook, Word, Excel, PowerPoint, Power BI) and other web-based applications. Ability to produce complex documents.
Strong analytical ability to collect, organize, analyze data, produce actionable reports, and recommend improvements.
Ability to work with periods of concentrated focus (up to 4 hours without a break) when required and adapt to changing circumstances.
No substantial exposure to adverse environmental conditions.
Health Care Worker Status may vary by department
Sensory Requirements
Close work, color vision, visual clarity, speech and hearing related tasks.
Physical Requirements
Sedentary work: Exerting up to ten pounds of force occasionally; mostly sitting with occasional walking/standing.
Constant sitting and keyboard use; occasional walking and standing as needed.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues, and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement.
Equal Opportunity Employer/Veterans/Disabled
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
Equal Opportunity Employer/Veterans/Disabled
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Revenue Integrity Senior Analyst - HMFP
role at
Beth Israel Deaconess Medical Center
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Under the direction of the Director, Revenue Integrity and Coding at Harvard Medical Faculty Physicians (HMFP) at the Beth Israel Deaconess Medical Center (BIDMC), the Revenue Integrity Senior Analyst contributes to Revenue Integrity and Coding oversight at the enterprise, which aims to maximize synergies across HMFP departments, initiate and lead revenue integrity and coding process improvement, identify and address risks, monitor key revenue integrity and coding operational and financial metrics, provide subject-matter expertise, and ensure adherence to established standards and policies.
Job Description:
Primary Responsibilities
Monitor departments’ adherence to professional charge reconciliation, work-queue, and professional coding quality expectations and support departments with education, process improvement, and follow-up.
Conduct periodic departmental reviews of professional charge reconciliation processes to ensure adherence to policies and confirm all professional charges are captured and reported accurately
Review and document changes within the charge description master (CDM) and fee schedule(s) and ensure these changes are implemented within appropriate systems. Route for approval according to HMFP’s established policies and procedures.
Lead annual, quarterly, and regular CDM and fee schedule maintenance activities.
Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement.
Support departments with analyzing services for coverage and reimbursement.
Work with HMFP departments to identify revenue management opportunities, staying current with government and commercial payer’s billing and coding requirements.
Develop, deliver, and revise revenue integrity and coding education and training programs in coordination with the Director and HMFP Compliance Department.
Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate stakeholders and provide any necessary follow-up.
Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly.
Monitor coder quality audit results and coder productivity. Support departments by establishing audit processes, education and training, process improvement, and follow-up.
Lead assigned revenue integrity and coding projects, committees, and meetings.
Develop and execute tools and processes to identify potential areas of delayed or lost revenue. Collaborate with departments on process improvement and necessary follow-up.
Build strong relationships and facilitate effective communication between key stakeholders. Collaborate with others to develop and implement action plans to resolve revenue integrity and coding issues.
Prepare oral and written reports and presentations summarizing reviews, findings, recommendations for improvement, and actions taken for the Director and other stakeholders.
Required Qualifications
Certification: Certified Professional Coder (CPC) required.
5 or more years of physician/professional revenue operations experience with a focus in one or more of the following areas: coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, and CDM management.
EPIC PB experience preferred.
Extensive knowledge of:
Revenue cycle processes and physician billing
Code sets including CPT, HCPCS, and ICD-10
Reimbursement theories including RBRVUs, MPFS, and managed care
NCCI edits and Medicare LCD/NCDs
Healthcare documentation, coding, and billing requirements, and federal/state regulatory requirements
Medical terminology, anatomy and physiology, and clinical department activities
Abilities:
Manage large complex project assignments, investigate, analyze, and resolve issues at a high level.
Excellent communication, presentation, organizational, analytical, and problem-solving skills. Must communicate effectively with physicians, leadership, and other billing personnel.
Independent problem-solving, strong attention to detail, and ability to work in a fast-paced, collaborative team environment.
Advanced skills with Microsoft Office (Outlook, Word, Excel, PowerPoint, Power BI) and other web-based applications. Ability to produce complex documents.
Strong analytical ability to collect, organize, analyze data, produce actionable reports, and recommend improvements.
Ability to work with periods of concentrated focus (up to 4 hours without a break) when required and adapt to changing circumstances.
No substantial exposure to adverse environmental conditions.
Health Care Worker Status may vary by department
Sensory Requirements
Close work, color vision, visual clarity, speech and hearing related tasks.
Physical Requirements
Sedentary work: Exerting up to ten pounds of force occasionally; mostly sitting with occasional walking/standing.
Constant sitting and keyboard use; occasional walking and standing as needed.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues, and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement.
Equal Opportunity Employer/Veterans/Disabled
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
Equal Opportunity Employer/Veterans/Disabled
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr