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Revenue Integrity Charge Analyst - Revenue Integrity, USA Health
Overview:
Equal Employment Opportunity Employer:
USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.
Responsibilities:
- Revenue integrity analyst provides education to employees, clinical departments, and provider offices as needed to facilitate an understanding of correct claim coding, use of CPT, ICD9, ICD-10 HCPCS, etc.
- Assigns pricing as needed and ensures pricing meets methodology within CDM.
- Ensures regulatory requirements are met for any CDM charge.
- Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in Cerner Patient Accounting.
- Supports timely implementation of coding and pricing updates (CPT/HCPCS), periodic UB Revenue Code updates, modifier revisions and regulatory updates to CDM.
- Serve as chargemaster liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues.
- Performs formal review of annual CPT/Diagnosis/HCPC changes and prepares educational documents by specialty highlighting significant changes.
- Primary resource for with the development of documentation templates and assignment of correct CPT/diagnosis codes to orders.
- Analyzes billing error and denial data to identify root causes.
- Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
- Analyzes file data for evidence of deficiencies in controls, duplication of effort, or lack of compliance with laws, government regulations and policies and procedures.
- Collaborates with facility and/or other personnel to analyze CDM billing processes and identify root causes for claims issues/rejections.
- Works with Information Systems and other departments to ensure that the appropriate CDM line-item charge and other necessary billing data are placed on the claim appropriately.
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Helps to clear suspended charges.Helps to distribute/follow up on out of bounds charges with areas.
- Helps identify missing charges and advises on corrective activity in the hospital departments.
- Assists with new supply charges.
- Helps with clean up of Optum database.
- Proficiency with Microsoft Excel.
- In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle.
- Strong analytical and problem-solving abilities.
- Excellent communication, interpersonal, and collaboration skills.
- Proficiency in the use of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes.
- Completes all mandatory department, educational and hospital requirements
- Adheres to current Infection Control and Safety Standards
- Regular and prompt attendance
- Ability to work schedule as defined and overtime as required
- Related duties as assigned
Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.
Qualifications:
- Associate's Degree in business or a related field from an accredited institution as approved and accepted by the University of South Alabama and 3 years of experience in revenue integrity operations, clinical charge capture, charge master, or revenue cycle operations. Required
- Bachelor's Degree Preferred
- Charge description master and professional or hospital billing experience. Preferred
- Certified Professional Coder (CPC) Preferred
- Certified Outpatient Coder (COC) Preferred
- CCA - Certified Coding Associate Preferred
- CCS-Certified Coding Specialist Preferred
- RHIT - Registered Health Information Technician Preferred
- Comparable combination of education and experience may substitute for the above requirements.
Equal Employment Opportunity Employer:
The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis. EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.
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