Senior Revenue Integrity Analyst

Senior Revenue Integrity Analyst

Job Profile Summary

Dayton Children’s Hospital is committed to providing quality healthcare while meeting increasing regulatory, compliance, and billing regulations. This position is responsible for planning and oversight of the revenue integrity analysts’ performance of essential department accountabilities, including reporting to department leadership about goal status. This position will be responsible for all aspects related to revenue integrity, including maintaining work queues, understanding, and applying yearly regulatory changes, maintaining the chargemaster, and preventing revenue leakage. The senior revenue integrity analyst works accounts in assigned Revenue Integrity work queues to facilitate accurate, compliant billing of patient accounts and assists revenue integrity analysts with completion of tasks and work queues. The position will be certified in Epic CDM Management/Revenue Integrity to create, edit, delete and research various CDM requests for all hospital departments for both hospital and professional billing. The senior analyst is responsible for establishing and enforcing the hospitals’ pricing, coding, and regulatory changes. The incumbent needs to have knowledge of how billing and the CDM interacts for chargemaster build and will assist in hospital decision making related to chargemaster requests. The position will also provide operational analytical support with regards to reimbursement, charge lag, revenue trends, and other revenue related items. The senior revenue integrity analyst will coordinate and collaborate the above actions with, but not limited to, Health Information Management, Information Systems, Billing, Finance and Operations.

 

Education

Bachelor’s degree required

Masters preferred

 

Experience

6-10 years healthcare

Experience with EPIC electronic health record

EPIC CDM/Revenue Integrity (HB and PB) certification within 6 months of employment required

Ability to research CPT and regulatory requirements

Experience with CPT and HCPCS codes and interpreting CPT guidance

Experience in healthcare billing, CMS Medicare and Medicaid reimbursement methodologies

Proficiency in Microsoft Office Tools (Outlook, Excel)

 

Preferred qualifications/skills

Trisus (Craneware) chargemaster experience

Strata experience

Registered Health Information Administrator (RHIA) Certification

 

Principal Duties and Responsibilities

 

1. Revenue Integrity/CDM 40%

• Develop and maintain charge description master (CDM) for hospital and professional billing, including hospital and professional fee schedules
• Works with clinical departments on charging questions and requests for additions or changes to the CDM
• Daily review of revenue integrity and charge review work queues.
• Works with billing team to understand denials and make changes in the CDM (where applicable) to prevent future denials on the front end.
• Evaluates and validates revenue data, trends, and key performance indicators to identify revenue cycle improvement opportunities. Provides operational analytical support with regards to reimbursement, charge lag and revenue trends
• Partners with compliance and clinical operations on operational and strategic initiatives
• Identifies and troubleshoots charge issues and opportunities through daily work queues, denial trends brought forth by billing team, and CDM reviews with clinical departments
• Follow up, education and training of various department staff on root cause of errors, including CPT rules and regulations, CMS regulations, Ohio Medicaid, and Epic charging processes.
• Works with the revenue cycle team, hospital and professional billing analysts, and Epic information systems teams as needed.
• Establishes and communicates hospital charging policies.
• Job knowledge of how CPT coding rules impact chargemaster build and provide feedback for appropriateness of requested changes.
• Monitors and maintains all aspects of Trisus Chargemaster solution.
• Produces and maintains hospital price transparency machine-readable file to ensure compliance with CMS regulations

 

2. Charge and Reimbursement Management and Analysis 20%

• Determine patient prices in accordance with principals of chargemaster standardization, governmental and non-governmental reimbursement methodologies, and with awareness of uninsured or non-covered patients
• Respond to department concerns about charging and reimbursement, research, communicate and help implement solutions based on regulation and financial impact analysis.
• Educate departments on reimbursement and billing matters related to CDM issues and payer fee schedules.
• Prepare and implement annual price increases.
• Approve changes and update fee schedules

 

3. Charge Reconciliation 15%

• Implement and educate department on charge reconciliation process.
• Monitor departments adherence to charge reconciliation process and escalate issues and non-compliance

 

4. Leading, Associate Mentoring and Process Improvement 15%
   • Functions as department leader on interdisciplinary teams involving special projects
   • Provides ongoing feedback, coaching and support to revenue integrity analysts
   • Orientates new revenue integrity analysts and provides education on principals of CDM management
   • Identifies opportunities to streamline processes and improve efficiency and revenue capture

 

5. Special Projects 10%
   • Assist manager and director with special projects, which are typically non-routine in nature and completed in addition to routine responsibilities