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Revenue Integrity Analyst
Overview:
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities:
The Revenue Integrity Analyst determines the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding, by reviewing and analyzing the medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices. This review includes the verification of coding, charging and billing data for accuracy and completeness and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, claims scrubber systems, or in the payer’s system. The Revenue Integrity Analyst will coordinate to ensure optimum process towards maintaining a low DNFB by clarifying any process failures, i.e., clinical documentation deficiencies, late charge entry IT related technical issues, etc.
This position also serves as a liaison between facility administration, patient accounts and ancillary department directors, regarding charging issues, clinical documentation issues and revenue opportunities. Providing review results and developing and coordinating educational in-services for facility staff related to charging/billing issues are also key responsibilities of this position. At times, this position may collaborate with the Compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.
Qualifications:
EDUCATION, EXPERIENCE, TRAINING
- Bachelor's degree in Healthcare, Business, or related field is required. (Combination of education and experience is also acceptable)
- Epic proficiency in Hospital Billing; preferred
- Two years’ experience in a role related to revenue capture/charging, auditing, coding is required.
- Use of an encoder software product for code assignment in an acute care setting; preferred.
- Strong quantitative, analytical and organization skills.
- Proficient in chart review, clinical record information systems and coding methodologies.
- Ability to understand and interpret medical records, hospital bills, and the Charge Master.
- Ability to understand all ancillary department functions.
- Excellent written and verbal communication skills.
- Excellent critical thinking skills.
- Ability to work independently in a time-oriented environment.
- Working knowledge of Medicare & Medicaid reimbursement system and coding structures preferred.
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
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