Revenue Integrity Analyst
Company: Highmark Health
Location: Richmond
Posted on: May 26, 2023
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Job Description:
Company :
Allegheny Health Network
Job Description :
GENERAL OVERVIEW:
This position performs reporting and analysis of the revenue cycle
for monitoring and problem resolution; assists staff with internal
and external system issues, audits and questions relative to
accounts receivable; acts a primary liaison with other parties to
resolve system issues and ensure compliance with all regulations;
participates in department/system initiatives involving testing and
other activities to ensure overall goals are met. Collaborates with
facility/department leadership on a continuum basis. Activities
include analysis (including root cause), monitoring & auditing,
reporting & education with regards to Revenue Cycle training &
problem resolution with all level of leadership including
physicians, service line VP's, CAO's, CFO's etc. Establishes and
implements appropriate internal controls to achieve complete and
accurate documentation & billing processes; collaborates and helps
to optimize clinical documentation through analysis and prioritized
evaluation. Assists with maintaining the integrity of the CDM
(charge description master) and the software program.
ESSENTIAL RESPONSIBILITIES:
Responsible for financial, statistical and operational projects;
present detailed analysis of A/R performance and other financial
reports and related outcomes/trends; researches and validates
clinical data used to support medical necessity of billed services,
conducts quality assurance reviews of various billing components,
technical requirements, supporting processes, systems and required
documentation; reviews outcomes with wide array of people (i.e.,
Practice/clinical Directors, Practice/clinical Managers, senior
leadership, Coding Manager, hospital case management, managed care
contracting and RCC management) and influences adjustments to
current facilities, practices.Assist with maintaining the integrity
of the CDM (charge description master) and the software program.
Performs other duties as assigned. (40%)
Performs ad hoc consultative research and coordination on current
issues of Revenue Cycle regulatory risk including medical necessity
denials; identifies a framework of continuous improvement to
accomplish programmatic goals; facilitates meetings both internal
and external; works collaboratively with system compliance
leadership to coordinate and manage RAC and payer audit appeals.
Serves as the Revenue Cycle regulatory liaison between the Practice
and the RCC for efficient management of accounts receivable, point
of service Revenue Cycle activity and all other areas within the
Revenue Cycle area; serves as an internal audit consultant to
clinical providers. Identifies barriers and implements corrective
action measures in partnership with leaders to ensure positive
outcomes. Provides ongoing guidance, training and support to
practices and departmental Revenue Cycle staff. Works
collaboratively with physicians, leadership, and health
professionals to accomplish organization and Revenue Cycle and
practice goals. (20%)
Responsible for monitoring and auditing of Revenue Cycle issues;
monitor facility departments, Practices and RCC staff performance
relative to current Revenue Cycle policies and procedures,
including medical necessity issues of billed services through
sample audits; research regulatory concepts for gaps and
opportunities to improve Revenue Cycle compliance; identify under-
and over-charge items for immediate resolution by the
provider/practice; identify areas for risk as well as improvement -
conducts assessments both desk level and on site. (10%)
Provides ongoing education to departments, practices and RCC staff
concerning practice management system, coding and regulatory
complexities (i.e., billing and A/R management workflows, policies
and requirements); develops and implements action and educational
plans to target resolution of Revenue Cycle issues; identify
training needs as well as appropriate hand-off for designated
topics; assist with training and implementation of PM system for
newly acquired Hospitals, ASC's and practices relative to front-end
Revenue Cycle edits or other systematic issues and supportive
medical record documentation. (10%)
Collaborates with Compliance, Budget Office, Patient Accounts,
Health Information Services, Internal Audit and other Revenue and
Finance departments on revenue management initiatives. (10%)
Develops and maintains a Quality Audit program and associated
reporting. Assists in performance of quality audits related to RI
liason and charge review coordinators identified areas of
opportunity. (10%)
Other duties as assigned.
QUALIFICATIONS:
Minimum
High School/GED
1-3 years in hospital or physician revenue cycle, billing, coding
or billing
Preferred
Bachelor's Degree in Business, Healthcare or related field
1 year in Project Management
1 year in a Epic-billing environment
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Disclaimer: The job description has been designed to indicate the
general nature and essential duties and responsibilities of work
performed by employees within this job title. It may not contain a
comprehensive inventory of all duties, responsibilities, and
qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal
standards and behavioral expectations as set forth in the code of
business conduct and company policies.
As a component of job responsibilities, employees may have access
to covered information, cardholder data, or other confidential
customer information that must be protected at all times. In
connection with this, all employees must comply with both the
Health Insurance Portability Accountability Act of 1996 (HIPAA) as
described in the Notice of Privacy Practices and Privacy Policies
and Procedures as well as all data security guidelines established
within the Company's Handbook of Privacy Policies and Practices and
Information Security Policy.
Furthermore, it is every employee's responsibility to comply with
the company's Code of Business Conduct. This includes but is not
limited to adherence to applicable federal and state laws, rules,
and regulations as well as company policies and training
requirements.
Pay Range Minimum:
$25.85
Pay Range Maximum:
$40.18
Base pay is determined by a variety of factors including a
candidate's qualifications, experience, and expected contributions,
as well as internal peer equity, market, and business
considerations. The displayed salary range does not reflect any
geographic differential Highmark may apply for certain locations
based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against
qualified individuals based on their status as protected veterans
or individuals with disabilities, and prohibit discrimination
against all individuals based on their race, color, age, religion,
sex, national origin, sexual orientation/gender identity or any
other category protected by applicable federal, state or local law.
Highmark Health and its affiliates take affirmative action to
employ and advance in employment individuals without regard to
race, color, age, religion, sex, national origin, sexual
orientation/gender identity, protected veteran status or
disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
)
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you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.
For accommodation requests, please contact HR Services Online at
HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and
Applicants Notice
Req ID: J220423
Keywords: Highmark Health, Richmond , Revenue Integrity Analyst, Professions , Richmond, Virginia
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