Remote - Revenue Integrity Analyst

As part of the Revenue Integrity department, the Revenue Integrity Analyst is responsible to identify and correct the processes and systems that lead to lost revenue opportunities and reduced reimbursement for the care provided to patients. As part of ensuring operational integrity of the charge posting processes the position performs and reviews regular audits that supports the maintenance and enhancement of Mosaic Life Care's charge capture, compliance and billing functions. In addition, the position explores potential charge capture workflow enhancements, the application of a consistent charge structure and reviews rate setting, according to industry standards, payer contracts, and denial trends. The position ensures that charges make it to billing by working with the departments and Technical Services to monitor that processes are in place to handle charge interface exceptions that might turn into lost revenue. The role may also be involved in the design and implementation of data extraction and analytics processes across departments and service lines that helps pinpoint potential revenue leakage. The position maximizes charge efficiency through: (1) Monitoring revenue cycle processes and staff functions; (2) Supporting Mosaic Life Care's revenue capture and integrity through evaluating the accuracy of charge capture and billing functions and staying apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of charge capture/billing workflow improvements. Resolves Epic WQs pertaining to CCI and MUE Edits, Denials, Missing Cost Center, Missing Charges, Charge Review WQs, Physician Missing Charges Reports and Revenue Guardian edits. Performs RAC audits and appeals. Assists with CDM updates; develop annual CPT/HCPC code updates and training. Performs other duties assigned.

• Through continuous process improvement efforts, works to ensure that every legitimate charge for services provided makes it to billing and that proper reimbursement is received for those services;
• Works with the departments and Technical Services to ensure the flow from the department’s charge capture process to billing is error free and all charges from the departments are making it to billing;
• Responsible for finding root cause reasons and proposing solutions for issues leading to revenue leakage and/or reduced reimbursement;
• Assists in overseeing Mosaic’s charge capture system to promote its accuracy and integrity across revenue-generating departments;
• Works with Patient Financial Services (PFS) to review items routinely being held by the claim scrubber that are charge/coding related and comes up with recommended resolutions that helps expedite cash flow; Liaison to PFS to review denials that are charge/coding related and with Contracts if payers are not paying as expected based on contract terms due to charge/coding issues; Summarizes hospital or health system-wide charge audit findings to executive staff, board members,
• Investigates billing errors and impacts to reimbursement potentially caused by inappropriate documentation, coding, medical necessity exceptions or charging and works in collaboration to come up with an action plan to resolve;
• Coordinates the hospital charge audit and RAC process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities.
• Reviews billing workflows and works with the appropriate teams to adjust systems/workflows to better catch errors and/or omissions prior to billing to reduce the DNFB;
• Work and resolve Epic CCI/MUE Edits, Revenue Guardian edits, Missing Charges WQs, Physician Missing Charges Report, Denials, Missing Cost Centers, and Charge Review WQs.
• Monitors fluctuations of various key performance indicators that may indicate areas needing attention; Works closely with the Chargemaster Analyst to review and implement changes when charge/coding issues are identified;
• Responsible for annual review and education of CPTs/HCPCs and update the CDM accordingly.
• Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualizes process changes for service line leaders; uses hospital denials data to support findings; and/or the compliance committee in efforts to ensure all charges are properly captured and reimbursed
• Other duties as assigned

• Bachelor's Degree - Finance; business, health, or public administration management; or related field; or in pursuit thereof. - Required

• 3 Years - Experience in hospital charge capture review, medical record review, and claims auditing, and in working with regulatory and policy compliance issues related to federal and state programs. - Required
• 2 Years - Coding experience - Required
• Clinical review experience - Preferred

• Certified Professional Coder (CPC) - Required within 1 Year Or
• Certified Coding Specialist-Physician-based (CCS-P) - Required within 1 Year Or
• Registered Health Information Administrator (RHIA) - Required within 1 Year Or
• Registered Health Information Technician (RHIT) - Required within 1 Year

• Travel to off-site locations may be required. - Required