St. Joseph's/Candler
Overview
Revenue Integrity Analyst responsible for assisting and completing functions to ensure timely, compliant, and accurate capture of charges and correct claims to various payers including governmental and non-governmental payers. The Revenue Integrity Analyst resolves pre-bill claim edits and Meditech account checks; reviews and enters accurate charges; completes charge corrections; monitors, tracks, and reports claims and/or charge capture trends. Must stay current with Centers for Medicare &Medicaid Services (CMS) regulations and managed care/commercial payer requirements and changes. Applies billing and coding knowledge to complex claim scenarios to resolve them in a compliant, accurate manner. Completes projects and other tasks as assigned by the department Director or designee. Education
Associates Degree - Required (Healthcare Preferred) Medical Terminology - Required Courses in computer technology, spreadsheets/project management, medical billing, and medical coding - Preferred Experience
2 Years hospital revenue cycle charging, claims processing, professional and/or hospital healthcare billing, denials management or related revenue cycle/financial experience - Required Knowledge of hospital billing & claim requirements, charge capture processes, CPT codes, modifiers, and other claims data, electronic record documentation and payer requirements including Medicare guidelines for documentation, charge capture, billing, and claims processing - Required Effective problem solving and attention to detail - Required Proficient in basic Excel, Word and PowerPoint – Required Experience with CPT/HCPCS coding, claims preparation, MUE and NCCI claims edits - Preferred License & Certification
Certified Professional Coder (CPC) or similar coding certification through accredited organization such as AAPC or AHIMA or Certified Revenue Cycle Professional/Specialist (CRCS) or Certified Revenue Cycle Representative (CRCR) through AAHAM or HFMA respectively – Required or must be obtained within one year of hire date. Core Job Functions
Reviews and resolves pre-billing claim edits including National Correct Coding Initiative (NCCI), Medical Unlikely (MUE), and other assigned claim clearinghouse edits daily. Ensures charges and related items are compliant and accurate. Completes manual charge entry and patient account reviews as assigned. This can include charge entry and pre-billing auditing of emergency department visits & procedures, outpatient IV infusion and injection charges, blood administration charges and other inpatient, outpatient or observation patient services/charges of SJ/C. Resolves account checks in Meditech daily to ensure timely submission of claims to payers including government and non-governmental payers. Identifies charge capture trends and claim edit trends to Revenue Integrity leadership and provides analysis and suggestions on possible solutions to improve clean claims submitted. Researches and communicates payer updates and changes to department, revenue cycle and clinical/service areas as appropriate. Research includes review and monitoring of assigned payer websites, newsletters, and other modes of communication. Participates in payer/managed care contract payer meetings to assist denials management and other revenue cycle leaders focusing on reducing avoidable denials. Assists co-workers in the department with other daily or weekly responsibilities as assigned including resolution of Meditech account checks, patient account tasks, floor charges, quality report exceptions, and other items as assigned. Completes charge audits to include post-claim reviews in the Trisus Claims Informatics tool, and other tools. May be assigned other duties to support timely, compliant and accuracy billing of patient services/charges. Affiliations
Seniority level: Entry level Employment type: Full-time Job function: Finance and Sales Industries: Hospitals and Health Care
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Revenue Integrity Analyst responsible for assisting and completing functions to ensure timely, compliant, and accurate capture of charges and correct claims to various payers including governmental and non-governmental payers. The Revenue Integrity Analyst resolves pre-bill claim edits and Meditech account checks; reviews and enters accurate charges; completes charge corrections; monitors, tracks, and reports claims and/or charge capture trends. Must stay current with Centers for Medicare &Medicaid Services (CMS) regulations and managed care/commercial payer requirements and changes. Applies billing and coding knowledge to complex claim scenarios to resolve them in a compliant, accurate manner. Completes projects and other tasks as assigned by the department Director or designee. Education
Associates Degree - Required (Healthcare Preferred) Medical Terminology - Required Courses in computer technology, spreadsheets/project management, medical billing, and medical coding - Preferred Experience
2 Years hospital revenue cycle charging, claims processing, professional and/or hospital healthcare billing, denials management or related revenue cycle/financial experience - Required Knowledge of hospital billing & claim requirements, charge capture processes, CPT codes, modifiers, and other claims data, electronic record documentation and payer requirements including Medicare guidelines for documentation, charge capture, billing, and claims processing - Required Effective problem solving and attention to detail - Required Proficient in basic Excel, Word and PowerPoint – Required Experience with CPT/HCPCS coding, claims preparation, MUE and NCCI claims edits - Preferred License & Certification
Certified Professional Coder (CPC) or similar coding certification through accredited organization such as AAPC or AHIMA or Certified Revenue Cycle Professional/Specialist (CRCS) or Certified Revenue Cycle Representative (CRCR) through AAHAM or HFMA respectively – Required or must be obtained within one year of hire date. Core Job Functions
Reviews and resolves pre-billing claim edits including National Correct Coding Initiative (NCCI), Medical Unlikely (MUE), and other assigned claim clearinghouse edits daily. Ensures charges and related items are compliant and accurate. Completes manual charge entry and patient account reviews as assigned. This can include charge entry and pre-billing auditing of emergency department visits & procedures, outpatient IV infusion and injection charges, blood administration charges and other inpatient, outpatient or observation patient services/charges of SJ/C. Resolves account checks in Meditech daily to ensure timely submission of claims to payers including government and non-governmental payers. Identifies charge capture trends and claim edit trends to Revenue Integrity leadership and provides analysis and suggestions on possible solutions to improve clean claims submitted. Researches and communicates payer updates and changes to department, revenue cycle and clinical/service areas as appropriate. Research includes review and monitoring of assigned payer websites, newsletters, and other modes of communication. Participates in payer/managed care contract payer meetings to assist denials management and other revenue cycle leaders focusing on reducing avoidable denials. Assists co-workers in the department with other daily or weekly responsibilities as assigned including resolution of Meditech account checks, patient account tasks, floor charges, quality report exceptions, and other items as assigned. Completes charge audits to include post-claim reviews in the Trisus Claims Informatics tool, and other tools. May be assigned other duties to support timely, compliant and accuracy billing of patient services/charges. Affiliations
Seniority level: Entry level Employment type: Full-time Job function: Finance and Sales Industries: Hospitals and Health Care
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