revenue integrity analyst

Baylor Scott & White Health

<div><h4 class="jobSectionHeader">About Us</h4>
Here at Baylor Scott &amp; White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.
Our Core Values are:<ul><li>
We serve faithfully by doing what's right with a joyful heart.</li><li>
We never settle by constantly striving for better.</li><li>
We are in it together by supporting one another and those we serve.</li><li>
We make an impact by taking initiative and delivering exceptional experience.</li></ul><h4 class="jobSectionHeader">
</h4><h4 class="jobSectionHeader">
Benefits</h4>
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott &amp; White Benefits Hub to explore our offerings, which may include:<ul><li>
Immediate eligibility for health and welfare benefits</li><li>
401(k) savings plan with dollar-for-dollar match up to 5%</li><li>
Tuition Reimbursement</li><li>
PTO accrual beginning Day 1</li></ul>
Note: Benefits may vary based upon position type and/or level.<h4 class="jobSectionHeader">
JOB SUMMARY</h4>
The Revenue Integrity Analyst 1 manages small projects and less complex service lines with some oversight, to ensure system-wide charge capture activities are performed in adherence to Baylor Scott &amp; White Health (BSWH) processes, policies, and applicable State and Federal guidelines. This position develops and maintains an exceptional working knowledge of their assigned primary service line(s), key relationships, and represents their service line(s), Revenue Integrity, and the broader Revenue Cycle to individual contributors as well as department, facility, and system leadership.
Hybrid position:<ul><li>
Will be onsite as well as department meetings and go-live events.</li></ul> 
ESSENTIAL FUNCTIONS OF THE ROLE<ul><li>
Assists in developing and maintaining a standardized charging methodology across all facilities for assigned service line(s) and partners with IS to design, build, validate, and test workflows impacting the Revenue Cycle. Develops detailed knowledge of charge capture workflow and mechanisms in order to support the IS teams with build required to achieve anticipated charging outcomes.</li><li>
Manages small charge capture projects and initiatives for assigned service line(s) with some oversight. Identifies problems by evaluating business requirements, examining data, negotiating organizational consensus, and synthesizing key messages for communication to all stake holders. Collaborates with numerous teams to support charging and billing accuracy efforts.</li><li>
Performs charge capture audits and education with some oversight. Designs, creates, and conducts audits and data-backed assessments to evaluate compliance with BSWH policies, procedures, and applicable laws related to charging practices for assigned service line(s). Formulates recommendations and corrective actions based on audit findings. Compiles written audit report detailing risks and financial impacts of deficiencies and proposing solutions for mitigation with some oversight.</li><li>
Examines accounts, claims, and clinical documentation for charge capture and billing quality and accuracy. Interprets documentation from medical records to validate charges. Provides feedback and education, as appropriate, depending on findings.</li><li>
Ensures the accuracy of the Charge Description Master (CDM). Evaluates critical data elements in the CDM to ensure adherence to CMS, AMA, third party payor, and other applicable state and federal guidelines across related departments. Validates all changes for data integrity.</li><li>
Reviews, interprets, and implements any coding and billing changes impacting the assigned service line(s) related to the quarterly and annual CPT update processes. Evaluates clinical processes to establish what changes are required to accommodate updated coding and billing regulations.</li><li>
Provides charge reconciliation education to assigned service line(s) and associated clinical departments, with oversight as needed. Performs frequent audits to ensure department compliance.</li><li>
Helps the success of new department, facility, service, workflow, or methodology go-lives by performing charge capture audits to ensure go-live success and rounding with department leadership and key stakeholders to ensure operational success while providing an avenue for questions and escalations.</li><li>
Performs other position appropriate duties as required in a competent, professional, and courteous manner.</li></ul>
KEY SUCCESS FACTORS<ul><li>
Exceptional verbal and written communication skills, manifesting in the ability to create communications that are informative, concise, and free of spelling and grammatical errors.</li><li>
Experience managing small sized projects preferred.</li><li>
Ability to execute tasks through an organized and detailed approach.</li><li>
Advanced knowledge of Excel to include formulas, functions, and pivot tables in order to examine large data sets and draw conclusions</li><li>
Ability to work alone and as a part of a team in a fast-paced, unpredictable, and deadline environment</li><li>
Exceptional organizational skills</li><li>
Proficiency in researching complex questions and providing recommendations</li><li>
Self-motivated with ability to identify and resolve issues and advance personal knowledge</li><li>
Ability to understand, interpret, establish impact of and respond to complex instructions from state and federal governing entities.</li><li>
Epic Hospital Billing, Professional Billing, and Chargemaster experience preferred.</li></ul><h4 class="jobSectionHeader">
</h4><h4 class="jobSectionHeader">
Belonging Statement</h4>
We believe that all people should feel welcomed, valued and supported.
QUALIFICATIONS<ul><li>
EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification</li><li>
EXPERIENCE - Less than 1 Year of Experience</li></ul></div>

Revenue Integrity Analyst 1

Greater Austin Allergy Asthma and Immunology

<div>The Revenue Integrity &amp; Financial Analyst ensures the organization&rsquo;s financial performance is optimized through accurate fee schedules, payer reimbursement analysis, and data-driven forecasting. This role bridges billing, finance, and operations&mdash;maintaining compliant, competitive charge structures while providing actionable insights into profitability and budget planning. This is a hybrid position in the Austin, TX area.
Key Responsibilities
Fee Schedule &amp; Reimbursement Management<ul><li>
Maintain and regularly update all CPT charge schedules across payers and subsidiaries.</li><li>
Benchmark internal fee schedules against Medicare, commercial payer, and regional competitor rates.</li><li>
Monitor annual CPT / RVU / HCPCS updates and recommend adjustments to pricing.</li><li>
Audit payers for underpayments and support contract renegotiation initiatives.</li></ul>
Profitability &amp; Margin Analysis<ul><li>
Calculate cost-per-procedure and contribution margins for allergy testing, injections, biologics, and ancillary services.</li><li>
Integrate data from NetSuite, Healix/Medico, and AdvancedMD to align actual results with expected reimbursement.</li><li>
Identify opportunities to improve margins through operational efficiency or payer optimization.</li></ul>
Budgeting &amp; Forecasting<ul><li>
Partner with the CFO to build the annual budget, including revenue, direct expenses, and overhead allocations.</li><li>
Create quarterly rolling forecasts based on updated volumes, reimbursement trends, and cost variances.</li><li>
Develop models for &ldquo;what-if&rdquo; scenarios (e.g., reimbursement changes, staffing shifts, or new location openings).</li><li>
Support financial presentations to leadership and ownership.</li></ul>
Reporting &amp; Data Integrity<ul><li>
Design and maintain dashboards summarizing key metrics (CPT profitability, payer trends, overhead ratios).</li><li>
Ensure consistent data mapping between NetSuite, AdvancedMD, and Healix/Medico.</li><li>
Collaborate with US Med Billing and internal teams to validate data accuracy and reconciliation.</li></ul>
Qualifications<ul><li>
Bachelor&rsquo;s degree in Accounting, Finance, Health Administration, or related field.</li><li>
5+ years of experience in healthcare finance, revenue integrity, or reimbursement analysis (multi-location practice preferred).</li><li>
Solid understanding of CPT/HCPCS coding, payer contracting, and revenue cycle workflows.</li><li>
Proficiency in Excel / Power BI / SQL (or equivalent data tools).</li><li>
Experience with NetSuite, AdvancedMD, or similar EHR and ERP systems preferred.</li><li>
Certifications desirable: CRCR (HFMA), CPC (AAPC), or CHFP (HFMA).</li></ul></div>

Revenue Integrity & Financial Analyst (Healthcare – Allergy & Immunology)

The University of Iowa

<div>The Senior Financial Analyst will provide analytical expertise and operational support for managed care contracting and revenue integrity initiatives, ensuring compliance with federal, state, and payor regulations. This role will play a pivotal part in optimizing reimbursement strategies, supporting financial forecasting, contract performance evaluation, and strategic decision-making within the University of Iowa Health Care and the Carver College of Medicine (CCOM).
In addition to being a key resource in managed care analytics, this position will collaborate across departments to enhance financial workflows, contract management methodologies, and reporting precision. The analyst will assess reimbursement models, payer performance metrics, and alternative payment arrangements to optimize financial outcomes and sustainability.
This role demands strategic problem-solving abilities, adaptability across multiple financial initiatives, and a commitment to data integrity and compliance. Working closely with leadership, this individual will play a critical role in aligning UI Health Care&rsquo;s managed care strategies with organizational financial goals, ensuring that contracting decisions support cost-efficient, high-quality care delivery.
Position responsibilities:
Contract Oversight and Managed Care Strategy<ul><li>
Support managed care contracting and revenue integrity initiatives, ensuring contract compliance, financial forecasting, and performance monitoring.</li><li>
Analyze commercial payer contracts, reimbursement models, and financial trends to optimize hospital and provider payment strategies.</li><li>
Maintain and assess contractual financial data, ensuring accuracy and alignment with regulatory requirements and hospital financial goals.</li><li>
Provide expertise in hospital reimbursement methodologies, including Medicare, Medicaid, and commercial payer models impacting managed care initiatives.</li></ul>
Financial Reporting and Data Integrity<ul><li>
Oversee the accuracy and integrity of financial reporting related to hospital contracting, payment models, and revenue integrity functions.</li><li>
Utilize financial analysis tools to generate detailed reports supporting compliance, strategic decision-making, and reimbursement optimization.</li><li>
Develop comprehensive reporting tools for management regarding payments, collections, denials, and appeals.</li><li>
Assist leadership by aligning financial analytics and reporting deliverables with regulatory requirements and strategic priorities.</li></ul>
Stakeholder Collaboration and Advisory<ul><li>
Serve as a key resource on hospital contracting and financial implications of managed care strategies.</li><li>
Collaborate across finance, clinical operations, and IT to refine financial workflows, enhance efficiency, and improve reporting methodologies, including outside of hospital based contracting projects when needed.</li><li>
Provide data-driven insights to executive leadership, supporting informed decision-making and strategic planning for managed care contracting.</li><li>
Establish and maintain strong relationships with external partners, including government agencies, payers, and affiliated healthcare entities.</li></ul>
Continuous Improvement and Strategic Support<ul><li>
Identify financial risks and implement controls to enhance reporting accuracy, reduce compliance issues, and optimize revenue integrity.</li><li>
Lead or contribute to process improvements in hospital contracting, reporting systems, and compliance strategies.</li><li>
Develop audit tools and conduct ongoing audit and review of decision support output to ensure accuracy of reported information.</li><li>
Supervise clerical support staff and students as needed, ensuring effective execution of financial operations and reporting tasks.</li></ul> 

<div>Required:<ul><li>
A Bachelor's degree in Business Administration with an emphasis in Accounting or Finance, or an equivalent combination of education and experience is required.</li><li>
3 years of experience in health care with an emphasis on reimbursement and contract management.</li><li>
3 years of financial analysis experience.</li><li>
3 years of experience using complex databases.</li><li>
Extensive knowledge of MS Excel and Office Suite.</li><li>
Proficient in statistical and financial analysis.</li><li>
Demonstrated ability to turn raw data into actionable information.</li><li>
Excellent written and verbal communication skills.</li><li>
Demonstrated competency in complex financial analysis and presentation.</li><li>
Relevant healthcare financial experience, particularly in hospital contracting and reimbursement models.</li><li><div>
Demonstrated experience working effectively in a welcoming and respectful workplace environment.</div></li></ul>
Desired:<ul><li>
Experience with Epic&rsquo;s Patient Accounting System, including Reporting Workbench.</li><li>
Epic Revenue Data Model (Clarity) certification.</li><li>
Understanding of or experience with CPT-4 and ICD-10 medical coding.</li><li>
Experience with dedicated contract analysis software.</li></ul>
Application Process: To be considered, applicants must upload a cover letter and resume (under the submission of relevant materials) that clearly address how they meet the listed required and desired qualifications of this position. Job openings are posted for a minimum of 7 calendar days. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification.
 Up to 5 professional references will be requested at a later step in the recruitment process. For questions, contact Sharon Walther at sharon-walther@uiowa.edu.
This position is not eligible for University sponsorship for employment authorization now or in the future.</div></div>

Senior Financial Analyst

Healthcare Retroactive Audits, Inc

Job Summary We are seeking a highly detail-oriented Data Analyst specializing in Healthcare Revenue Integrity, with a focus on underpayments and data flow management.This role is responsible for analyzing, validating, and routing healthcare revenue data to ensure accurate identification and resolution of underpayments. The ideal candidate brings strong analytical skills, a high level of organization, and the ability to work with precision in a fast-paced environment.This position plays a critical role in optimizing revenue recovery and ensuring data accuracy across operational workflows.Responsibilities<ul><li>Analyze healthcare revenue data to identify underpayment discrepancies and patterns</li><li>Validate data accuracy across multiple systems prior to processing and distribution</li><li>Route accounts to the appropriate internal teams (auditing, collections, escalation) based on findings</li><li>Monitor and execute data workflows to ensure completeness and integrity</li><li>Identify data inconsistencies, missing information, and processing errors, and resolve them proactively</li><li>Maintain detailed tracking logs and audit-ready documentation of all processed data</li><li>Collaborate with cross-functional teams to support issue resolution and workflow efficiency</li><li>Support reporting efforts by summarizing data trends and operational insights</li><li>Identify opportunities to improve data processes and support automation initiatives</li></ul>Skills<ul><li>Strong analytical and problem-solving skills</li><li>High attention to detail and ability to work with large datasets accurately</li><li>Proficiency in SQL and Excel</li><li>Experience with data visualization tools (Power BI or Tableau preferred)</li><li>Ability to manage multiple priorities in a structured, deadline-driven environment</li><li>Strong organizational and time management skills</li><li>Excellent communication and collaboration skills</li></ul>Preferred Qualifications<ul><li>Experience in healthcare revenue cycle or claims data (835/837, underpayments, denials)</li><li>Familiarity with healthcare billing systems or EHR platforms</li><li>Exposure to workflow tools or automation platforms</li></ul>Pay: $65,481.05 - $78,858.89 per yearBenefits:<ul><li>401(k)</li></ul>Work Location: Remote

Data Analyst – Healthcare Revenue Integrity (Underpayments & Data Flow

<div>The Financial Analyst provides analysis and operational support for managed care contracting and revenue integrity initiatives, ensuring compliance with federal, state, and payor regulations. This role plays a pivotal part in optimizing reimbursement strategies, supporting financial forecasting, contract performance evaluation, and strategic decision-making within the University of Iowa Hospitals &amp; Clinics (UIHC) and the Carver College of Medicine (CCOM).
In addition, collaborating in managed care analytics, this position will collaborate across departments to enhance financial workflows, contract management methodologies, and reporting precision.
Position Responsibilities:
Contract Oversight and Managed Care Strategy<ul><li>
Support managed care contracting and revenue integrity initiatives, ensuring contract compliance, financial forecasting, and performance monitoring.</li><li>
Assist with analyzing commercial payer contracts, reimbursement models, and financial trends to optimize hospital and provider payment strategies.</li><li>
Maintain and assess contractual financial data, ensuring accuracy and alignment with regulatory requirements and hospital financial goals.</li><li>
Support hospital reimbursement methodologies, including Medicare, Medicaid, and commercial payer models impacting managed care initiatives.</li></ul>
Financial Reporting and Data Integrity<ul><li>
Support the accuracy and integrity of financial reporting related to hospital contracting, payment models, and revenue integrity functions.</li><li>
Assist in utilizing financial analysis tools to generate detailed reports supporting compliance, strategic decision-making, and reimbursement optimization.</li><li>
Support in the development of comprehensive reporting tools for management regarding payments, collections, denials, and appeals.</li><li>
Assist leadership by aligning financial analytics and reporting deliverables with regulatory requirements and strategic priorities.</li></ul>
Stakeholder Collaboration and Advisory<ul><li>
Assist with hospital contracting and financial implications of managed care strategies.</li><li>
Collaborate across finance, clinical operations, and IT to refine financial workflows, enhance efficiency, and improve reporting methodologies, including outside of hospital based contracting projects when needed.</li><li>
Provide data-driven insights to management, supporting informed decision-making and strategic planning for managed care contracting.</li></ul>
Continuous Improvement and Strategic Support<ul><li>
Identify financial risks and implement controls to enhance reporting accuracy, reduce compliance issues, and optimize revenue integrity.</li><li>
Contribute to process improvements in hospital contracting, reporting systems, and compliance strategies.</li></ul>
<div>Required Qualifications:<ul><li>
A Bachelor's degree in Business Administration with an emphasis in Accounting or Finance, or an equivalent combination of education and experience is required. 
Demonstrated ability to work collaboratively and communicate financial concepts clearly.</li><li><div>
Familiarity with Excel or financial analysis tools.</div></li><li><div>
Excellent verbal and written communication skills.</div></li><li><div>
Demonstrated experience working effectively in a welcoming and respectful workplace environment.</div></li></ul>
Desired Qualifications:<ul><li>
Experience with Epic&rsquo;s Patient Accounting System, including Reporting Workbench.</li><li>
Understanding of or experience with CPT-4 and ICD-10 medical coding.</li><li>
Knowledge of EPIC, Power BI, or Tableau.</li><li>
Knowledge of UI and UI Health Care policies and procedures.</li></ul>
Application Process: To be considered, applicants must upload a cover letter and resume (under the submission of relevant materials) that clearly address how they meet the listed required and desired qualifications of this position. Job openings are posted for a minimum of 7 calendar days. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification.
 Up to 5 professional references will be requested at a later step in the recruitment process. For questions, contact Sharon Walther at sharon-walther@uiowa.edu.
This position is not eligible for University sponsorship for employment authorization now or in the future.</div></div>

Financial Analyst

Parallon

<div><h5 class="jobSectionHeader">Introduction</h5>
Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Billing Integrity Analyst Credentialed with Parallon you can be a part of an organization that is devoted to giving back!<h5 class="jobSectionHeader">
Benefits</h5>
Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing 
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) 
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock 
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance. 
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more 
</li><li>
Consumer discounts through Abenity and Consumer Discounts 
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships 
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships) 
</li><li>
Colleague recognition program 
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) 
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location. 
Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the Parallon family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Billing Integrity Analyst Credentialed to help us reach our goals. Unlock your potential!<h5 class="jobSectionHeader">
Job Summary and Qualifications</h5>
The Billing Integrity Analyst (credentialed) is responsible for determining the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPTs, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits or exceptions detected during system processing of the claim in Patient Accounting, Relay Health or the payer. Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and HCA standards. Combines or splits accounts as appropriate. Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities. Provides charge review results and develops and coordinates educational in-services for facility staff related to charging/billing issues. Coordinates retrospective, concurrent, patient requested, and external billing audits. Reviews denial trends for documentation and charging opportunities. Serves as a primary contact for charge related SSC and facility inquiries and issues.
In this role you will:<ul><li>
Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers and condition codes, as appropriate.</li><li>
Identify charging, chargemaster coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues that are identified while working on edits.
</li><li>Serve as charge master liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary
</li><li>Review Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Billing Integrity procedures and implement changes as needed.</li><li>
Maintain billing education, attend webcasts and conference calls as required.</li></ul>
Qualifications:<ul><li>
Associate Degree or above; or healthcare license/certification required.</li><li>
Minimum 1 year directly related Healthcare experience or coding experience required.
</li><li>Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews preferred.</li><li>
Healthcare certification/licensure such as RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential, LPN, LVN, RT, PT, etc., can be accepted lieu of degree with work experience.</li></ul>
Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. 
&quot;There is so much good to do in the world and so many different ways to do it.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
Be a part of an organization that invests in you! We are reviewing applications for our Billing Integrity Analyst Credentialed opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Billing Integrity Analyst Credentialed

Optum

<div>Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
As a Coding Compliance Analyst, you will be responsible for procedure and diagnostic coding of professional charges. Works closely with clinical department physicians and staff to ensure accurate and compliant coding and maximization of revenue through initial coding.
Schedule (FT, 40 hours): Will work 8-hr shifts, Monday-Friday. Must be flexible with schedule changes depending on business need. Typical business hours range from 6am - 6pm. (Preferably EST or CST).
Role is fully remote.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:<ul><li>
Participates in the identification and resolution of areas requiring additional intervention through established Coding/Billing and Corporate Compliance work plans</li><li>
Develops and implement clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or deficiencies identified through documentation/coding and billing compliance audits</li><li>
Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives</li><li>
Identifies trends that result in lost revenue and educates provider as appropriate</li><li>
Assist in the review and update of annual Revenue Integrity &amp; Education work plan and audit schedule</li><li>
Performs formal review of annual CPT/Diagnosis/HCPCS changes and prepares educational documents by specialty highlighting significant changes</li><li>
Trains providers, staff, and others in small and large group sessions</li><li>
Meet deadlines, productivity targets as defined in the Coding/Billing Compliance work Plan</li><li>
Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, managers, physicians, and medical leadership</li><li>
Conducts random and scheduled internal audits of physician billing and medical records documentation to ensure: Correct Coding (CPT, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third-party billing regulations</li><li>
Conducts quarterly audits of Coding staff to ensure correct coding and to identify training opportunities</li><li>
Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership</li><li>
Works collaboratively with clinical department physicians, mid-level providers, and other staff to ensure appropriate and compliant documentation, coding, and billing practices</li><li>
Develops and tracks progress of internal audit schedules</li><li>
Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions</li><li>
Utilizes the Internet, intranet, internal reference library, available workshops and/or seminars and other sources to stay current with government and local third-party payer coding, specialty specific and reimbursement rules, and requirements</li><li>
Measures and reports coding trends as compared to national standards; or claim/documentation reviews. Documents and reports result to all appropriate parties</li><li>
Monitors and productivity reports and other data as requested by manager</li><li>
Participate in all governmental and third-party insurance audits</li><li>
Assist in developing Revenue Integrity and Education Policies and Procedures</li><li>
Comply with all established departmental policies, procedures, and objectives</li><li>
Maintains all Professional certifications</li><li>
Attends a variety of meetings as required or directed</li><li>
Performs other similar and related duties as required or directed</li><li>
Must be able to work as a team and independently as needed</li><li>
Regular, reliable, and predicable attendance is required</li></ul>
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:<ul><li>
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays</li><li>
Medical Plan options along with participation in a Health Spending Account or a Health Saving account</li><li>
Dental, Vision, Life&amp; AD&amp;D Insurance along with Short-term disability and Long-Term Disability coverage</li><li>
401(k) Savings Plan, Employee Stock Purchase Plan</li><li>
Education Reimbursement</li><li>
Employee Discounts</li><li>
Employee Assistance Program</li><li>
Employee Referral Bonus Program</li><li>
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)</li></ul>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma/GED (or higher)</li><li>
Certified Professional Coder (CPC, CCS-P, CEMC, CPMA or COC)</li><li>
1+ years of experience utilizing standard scoring (CMS) methodologies to report findings to providers</li><li>
1+ years of experience employing clinical references with the auditing process</li><li>
1+ years of experience with Apply CPT and ICD-10 coding convention to documentation guidelines</li><li>
1+ years of experience with Apply CMS and other payer constraints to final code and documentation determination</li><li>
1+ years of demonstrated experience in a physician/professional billing environment</li><li>
1+ years of demonstrated experience with third party payer guidelines</li><li>
Ability to obtain CPMA within 1 year of employment</li></ul>
Preferred Qualifications:<ul><li>
Experience with ICD-10, CPT and HCPCS coding</li><li>
Experience with auditing physician medical records utilizing E+M guidelines</li><li>
Experience with Microsoft Office Suite (Excel, Word, Power Point) or successful completion of related courses. Must show proficiency in current billing software within six (6) months</li><li>
Demonstrated experience in the application of medical terminology, anatomy and physiology or successful completion of related college courses</li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #GREEN</div>

Coding Compliance Analyst

Search 10000+ Revenue integrity analyst jobs near you this March. New roles added regularly across leading industries. Apply today.