Revenue Integrity Analyst II

Revenue Integrity Analyst II

1.Analyze data, develop reports, review trends, and recommend enhancements as defined by the RI leadership team. Proactively seeks out positive or negative trends in charge/coding capture and editing processes to facilitate the sharing of best practice and performance improvement opportunity identification.
2. Understands and assists in other areas of the revenue cycle to support the quality and compliance of charges and documentation.
3. Participates, researches and follows-up on topics presented at department and system-wide initiatives. These may include audits and reviews for government, commercial and third party payers.
4. Monitors status of RI activities using a defined tracking system, ensuring timely responses. Assists in the determination of appropriate responses and activities in collaboration with others involved including the care site teams, external business partners/vendors, compliance, legal counsel, health information management, and designated areas in the response process.
5. Assists manager with interviews, onboarding, monitoring and measuring goals, annual reviews and metric design activities. Coordinates and oversees orientation and training for new and established associates and associated partners in designated areas, validates competency and performs retraining activities. Oversees productivity, vacation coverage and work assignments.
6. Stays current in specific areas of focus. Provides education and guidance to service line leadership, providers, and front line clinical associates regarding updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals, to facilitate corrective action planning for improved processes.
7. Complies with all CMS, Federal and State regulations, and payor guidelines, and ensures consistent and compliant application with charge/coding capture, charge editing, and audit and reimbursement practices. Researches and collaborates on regulation updates to ensure all necessary changes are incorporated into daily workflows.
8. Ensures timely accuracy of revenue capture for a specific service line(s), including validation that documentation supports charges submitted, all charges/coding are aligned with procedure performed, and charges/coding are consistent with Federal, State, and payer guidelines.
9. Acts as a subject matter resource to team and escalates to leadership as needed. Supports SCL and future acute care sites with Epic, downstream system, upgrades and new functionality.
10. Promotes mission, vision, and values of SCL Health, and abides by service behavior standards.
11. Performs other duties as assigned.

Minimum Qualifications Required

Associates Degree in healthcare related field or two (2) years of prior experience leading others or leading project or programs.

Certified Revenue Cycle Representative (CRCR) Certification completed within 3 months of hire.

Plus one of the following certifications:   Current certification as a coder through AAPC or American Health Information Management Association (AHIMA), or Healthcare Finance Management Association (HFMA).
Three (3) years of direct related experience in revenue cycle operations in an acute and medical office.

Preferred
Bachelors Degree is preferred

Proficiency in EPIC is preferred Prior educator, preceptor, trainer experience is preferred
Knowledgeable of CMS Guidelines ( Medicare/Medicaid)

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Regular attendance to perform work on site during regularly scheduled business hours or scheduled shifts is required. Strong oral and written communication skills with the ability to communicate effectively with diverse audiences.
2. Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
3. Demonstrate attention to detail and accuracy in work product.
4. Strong problem solving and analytical skills.
5. Ability to work independently and as part of a team.
6. Basic mathematics skills.
7. Intermediate skills in Word and Excel
8. Experience collaborating
communicating with site staff and leadership and system office personnel

Interact with others by effectively communicating, both orally and in writing.- and -Operate computers and other office equipment requiring the ability to move fingers and hands.- and -See and read computer monitors and documents.- and -Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.- and -May require lifting and transporting objects and office supplies, bending, kneeling and reaching.