Revenue Integrity Analyst Job

Children's Health - Finance Careers

Job Number: 52962

Location: Dallas, TX

Date Posted: 11-9-2017

Description:

POSITION SUMMARY:

The Revenue Integrity Analyst is responsible for establishing and maintaining the Charge Description Master (CDM) as well as department charge capture processes and controls under the direction of the Director of Revenue Integrity. This position acts as the liaison between Revenue Cycle and revenue-generating departments throughout Children's Healthcare System to ensure charging practices and departmental CDMs are in compliance with Federal and State billing regulations while simultaneously ensuring appropriate, optimal reimbursement. This position also works closely with Information Systems to complete and test charge builds.

Job Profile:

  • Requires in-depth professional knowledge and practical/applied expertise in own discipline and basic knowledge of related disciplines within the broader professional field
  • Has knowledge of best practices and how own area integrates with others; demonstrates awareness of the industry, including regulatory, evolving customer demands, and the factors that differentiate the organization in the market
  • Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements
  • Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
  • Impacts a range of customer, operational, project or service activities within own team and other related teams; works within broad guidelines and policies
  • Works independently, receives minimal guidance
  • Explains difficult or sensitive information; works to build consensus

Job Specific Responsibilities:

  • Directs ongoing CDM reviews ensuring the accuracy and completeness of the departmental charge masters, which encompasses the coordination, monitoring and approval of all changes made to department CDMs. Performs retrospective chart reviews comparing clinical documentation to charges posted to patient account to assess accuracy and completeness of department charge capture. Reduces compliance risks through studying, reporting and making recommendations relative to on-going and emerging compliance issues. Oversees the annual review of the CDM through meetings with clinical departments. Participates in project teams reviewing system programs/services relative to the development and/or changes to hospital CDM. Performs ongoing monitoring of estimated gross revenue impact, directly related to already strengthened internal controls, driven by Revenue Integrity audits/reviews. Serves as the primary contact for all charge-related Patient Financial Services inquiries and issues.
  • Provides assistance to staff in clinical/financial areas regarding the use of charges. Reports, investigates, and assists in resolution of compliance and charging issues. Works with Managed Care to gain an understanding of claims filing and coding requirements affecting reimbursement from major Managed Care payors. Assist Managed Care personnel with billing/contracting issues as needed. Audits Epic preference lists and documentation flow sheet rows quarterly to ensure revenues originating from these charging mechanisms are accurate, complete and compliant. Maintains detailed documentation of the charging mechanisms used to post revenue throughout the hospital.
  • Develops and presents educational material for department management regarding the following: CDM update and maintenance procedures for billing codes and pricing; procedures for CDM "new item" requests; department-specific changes to charging/billing regulations affecting the CDM; the relationship of the CDM to productivity measures and ultimate facility reimbursement; importance of capturing revenue through the establishment of a complete department CDM; and education and development of viable charge reconciliation procedures. Follow-up on billing issues created by charge capture errors.
  • Provides assistance in completion of annual pricing review. This includes preparing the files requested and making price changes in the Epic Fee Schedule master file as requested. Builds new charges and makes revisions to existing charges in the Epic EAP Master file. Distributes monthly EAP/CDM reports to departmental management on a monthly basis. Maintains current knowledge of Epic functionality as it relates to charging mechanisms and EAP build. Assists in the completion and verification of changes stemming from the annual CDM review.
  • Provides assistance to staff in clinical areas in relation to the department charges. Documents discussions and maintains meeting minutes to assess whether hospital-wide education is needed on a given charging topic. Reports, investigates, and assists in resolution of compliance issues related to the CDM. Supports Clinical Operations administering education through Children's CHEX system. Maintains detailed documentation of the charging mechanisms used to post revenue throughout the hospital. Resolves errors identified through the Epic work queues related to CDM records (i.e., High-Dollar and Zero Price work queues).
  • Runs reporting to detect potential charging anomalies by department. Prepares documented follow-up on billing issues created by charge capture errors.
  • Attend workshops and seminars as required to maintain a high level of knowledge and capabilities
  • Perform other duties and special projects as assigned

Experience:

  • At least two (2) years of progressive healthcare revenue cycle experience required
  • Strong working knowledge of CPT and HCPCS codes, Revenue Codes, NCCI edits, and OPPS guidelines as they relate to CDM required
  • Ability to understand medical terminology, human anatomy, medical record documentation, insurance terms, and billing functions throughout the complete revenue cycle required
  • Capable of interpreting CMS memos/bulletins as well as other payer communications required
  • Extensive experience using spreadsheet and database computer applications; this includes development of reporting tools to support management decision-making preferred

Specific Knowledge, Skills and Abilities:

  • Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
  • Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
  • Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
  • Develop and use collaborative relationships to facilitate the accomplishment of work goals.
  • Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
  • Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
  • Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Effectively manage one's time and resources to ensure that work is completed efficiently.
  • Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
  • Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.
  • Assimilate and apply new job-related information in a timely manner.
  • Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

Education:

  • Two-year Associate's degree or equivalent experience required
  • Four-year Bachelor's degree or equivalent experience preferred

Licenses and Certifications:

  • Certification in Epic HB, EAP and FSC Epic Master Files preferred
  • RHIA, RHIT, and/or CCS preferred
  • Epic Certification required for some positions; must be obtained within 6 months of placement in the applicable position required

Physical Demands:

  • Sedentary - Exerting up to 10lbs. occasionally or negligible weights frequently; sitting most of the time.

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