Job description

Location: Chicago, IL

Hospital: RUSH University Medical Center

Department: Revenue Cycle Revenue Integrit

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (8:00:00 AM - 4:00:00 PM)

Summary

The Revenue Integrity Analyst uses advanced knowledge of coding, CDM, charge capture, and auditing to solve complex charging scenarios, provide education and assistance to operational departments, support fellow team members, and develop processes/procedures to ensure accurate and timely capture of all chargeable procedures. The Revenue Integrity Analyst also provides high-level professional support in working advanced outpatient coding edits as well as auditing charges for service lines with potential missed revenue opportunities. The individual who holds this position exemplifies the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.

Responsibilities

Job Responsibilities:

Use logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines
Responsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner
Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing
Audit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits
Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts
Identify trends, analyze to propose and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges
Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts
Meets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager
Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement
Provides input and implements process improvement initiatives recognizing revenue enhancement and charge integrity opportunities
Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement
Engages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned

Other Information

Required Job Qualifications:

Associates degree or higher
Minimum 2-4 years of healthcare experience working with billing, charge entry, charge capture, or CDM
AAPC or AHIMA certification
Proficient and functional knowledge of reviewing charges in the Epic EHR.
Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiers
Excellent written and oral communication skills along with problem-solving
Proficiency with MS Office Suite
High degree of accuracy and ability to collaborate with others

Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

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