Revenue Integrity Analyst Job Description
Revenue integrity analyst
provides education to employees and provider offices as needed to facilitate an understanding of correct claim coding, use of CPT, ICD9, ICD-10 HCPCS, etc.
Revenue Integrity Analyst Duties & Responsibilities
To write an effective revenue integrity analyst job description, begin by listing detailed duties, responsibilities and expectations. We have included revenue integrity analyst job description templates that you can modify and use.
Sample responsibilities for this position include:
Analyze and resolve specific billing edits that require HCPCS/CPT coding basedonthe chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Healthsystems
Supports timely implementation of coding 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
Revenue Integrity Analyst Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Revenue Integrity Analyst
List any licenses or certifications required by the position: EPIC, CDM, CPC, CCS, AHIMA, MGMA, HFMA, CPMA, CIC, RHIA
Education for Revenue Integrity Analyst
Typically a job would require a certain level of education.
Employers hiring for the revenue integrity analyst job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Finance, Education, Business, Healthcare, Business/Administration, Healthcare Administration, Accounting, Nursing, Associates, Management
Skills for Revenue Integrity Analyst
Desired skills for revenue integrity analyst include:
CPT
HCPCS
Microsoft Office
ICD coding
CPT-HCPCS
Chargemaster components
Coding guidelines and CMS Medicare reimbursement methodology
Inpatient and outpatient billing requirements
Revenue cycle process
Third party reimbursement methodologies
Desired experience for revenue integrity analyst includes:
Implements CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes
Analyze and resolve specific billing edits that require clinical expertise and that are delaying claims from processing in the Patient Accounting and/or SSI systems
Perform charge audits by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed
Serve as a liaison between the SSC Charge Master department and the facility ancillary department directors
Participate as a member of the facility FECC Committee and report charging issues as appropriate
Serves as a subject matter expert and in a consultative role to various levels of customers
Revenue Integrity Analyst Examples
1
Revenue Integrity Analyst Job Description
Job Description Example
Our company is growing rapidly and is hiring for a revenue integrity analyst. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for revenue integrity analyst
- Provides guidance and education related to billing and charge capture of services to multiple staff levels
- Conducts special projects and special studies to facilitate revenue management as required for system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews
- Experience in health care laboratory environment is preferred
- Analyze and approve audit requests received from insurance companies
- Interact with insurance based auditors in resolving questions or concerns related to charge defense audits
- Maintain tracking of insurance defense audits and coordinate obtaining the medical record
- Communicate approved and denied insurance defense audits to on-site and hospital based Revenue Integrity staff
- Complete charge transactions as directed by on-site Revenue Integrity Analysts
- Generate and provide audit pre-bill to insurance representative and Revenue Integrity Analyst
- Coordinate rebilling of accounts through the Billing Department
Qualifications for revenue integrity analyst
- Generate audit package for imaging to the patient folder in On-Base
- Provide completed audit detail bill to logging for reconciliation
- Initiate refund request and provide any required documentation required for refund process
- Maintain statistical data in the audit database
- Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact
- Serves as a subject matter expert and in a consultative role to various levels of customers including patient accounting systems
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Revenue Integrity Analyst Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of revenue integrity analyst. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for revenue integrity analyst
- Responsible for the oversight and updating of the Epic Charge Description Master and associated functions within the Revenue Integrity Department of RCM
- Works with assigned revenue producing departments to ensure the ongoing consistency of the CDM including accurate descriptions, coding, additions, deletions, pricing, RVUs and any other changes
- Maintains timely turnaround of all CDM requests in accordance with established Service Level Agreements (SLA) or regulatory deadlines
- Analyzes reports and works queues to determine areas of improvement and determine appropriate plan of action
- Be responsible for charge reconciliation and analysis of financial data as it relates to regulatory compliant charging and billing guidelines
- Under general supervision this regional position supports the entire revenue cycle by using clinical expertise and analytical skills to resolve charging and billing issues
- Establish and oversee the structure and processes to ensure timely/accurate charge capture and revenue monitoring policies and procedures are adhered to
- Partner with department leaders to ensure clear accountability for daily charge capture and revenue monitoring, to include consultation on eliminating late/lost charges
- Support departments in analyzing and resolve issues related to charge capture
- Review, develop, implement, evaluate, and revise charge guidelines to optimize revenue management
Qualifications for revenue integrity analyst
- Coding Certificate - CCS
- Coding certificate program (CCS) including medical terminology, anatomy, and physiology or equivalent
- Charge Description Master experience, Preferred
- EPIC certification in CDM Management, PB or HB Claims certified Preferred
- Billing experience (professional and/or hospital) preferred
- Clinical experience including RN, NP, RT, a plus
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Revenue Integrity Analyst Job Description
Job Description Example
Our innovative and growing company is looking for a revenue integrity analyst. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for revenue integrity analyst
- Establish and maintain revenue integrity processes with quality assurance to provide a systematic, structured method to monitor and evaluate department compliance
- Stay current with laws, regulations, PH&S policies and procedures, and trends to assess potential impact on WMSA’s financial goals and objectives
- Identify risks and develop mitigation plans, as necessary
- Assists with special projects related to price increases, special requests from clients, system conversions, or implementation of new CDM tools
- Provides support to internal and external departments by assisting with process automation and maintaining system compliance and data integrity
- Participates in and/or coordinates system enhancements ensuring system integrity through appropriate testing, validation, and implementation
- For special audits
- Insures the reconciliation of member eligibility to revenue receipt for each member, each month
- Reviews pricing structure and creates and maintains resource materials for internal and external customers
- Maintains dashboard of financial activity, reviewing and reporting anomalies in a timely fashion
Qualifications for revenue integrity analyst
- Charge Reconciliation with the individual departments for any rejected charges
- Must be able to act independently with only general supervision
- Requires the ability to adapt quickly to new systems, tools, procedures, and protocols
- RN analytic and auditing experience preferred or current acute hospital nursing experience
- BS/BA degree or equivalent combination of education and experience required
- Five (5) years of experience as financial analyst in hospital decision support or database management
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Revenue Integrity Analyst Job Description
Job Description Example
Our innovative and growing company is looking for a revenue integrity analyst. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for revenue integrity analyst
- Identify charging or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues
- Review all regulatory and Parallon compliance correspondence and adheres to all guidelines
- Maintain mandated education and attend necessary webcasts/conference calls
- Oversee assignment of observation and injection/infusion charges, as applicable to SCC
- Identify charging,chargemaster coding, or clinicaldocumentation issues and work with appropriate leadership and ancillary departments to resolveissues that are identified while working onedits
- Continuously works to identify revenue opportunities
- Analyzes large data sets to identify revenue opportunities and prevent revenue loss
- Troubleshoots and optimizes and functional issues that may arise
- Participates in CAB call for Service Now Tickets submitted by Clinical and/or Operational departments
- Analyzes and processes charging and rate errors within EPIC Work Queues other claim edit or charge review issues that occur
Qualifications for revenue integrity analyst
- Ability to create, analyze, interpret and report on outcomes and variances
- Previous Clinical experience including RN, NP, RT, a plus
- Coding Credential (e.g., RHIT, CCS) or equivalent revenue cycle experience is required
- 2 to 3 years of healthcare experience
- General knowledge of Reimbursement Regulations
- Participates in the identification and resolution of areas requiring additional intervention through established Billing and Corporate Compliance work plans
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Revenue Integrity Analyst Job Description
Job Description Example
Our company is searching for experienced candidates for the position of revenue integrity analyst. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for revenue integrity analyst
- Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives
- Assists in the review and update of annual Revenue Integrity & Education work plan and audit schedule
- Trains providers, staff and others in small and large group sessions
- Meets deadlines, productivity targets as defined in the Billing Compliance Work Plan
- Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, practice managers, physicians, and medical leadership
- Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership
- Works collaboratively with clinical department physicians, mid-level providers and other staff to ensure appropriate and compliant documentation, coding and billing practices
- Develops and tracks progress of internal audit schedules
- Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions
- 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
Qualifications for revenue integrity analyst
- Completing the Facility Charge Tickets, Charging Observation Hours, Charge Batch Entry, and performing
- Measures and reports coding trends as compared to national standards
- Monitors and reports productivity and other data as requested by manager
- Participates in all governmental and third party insurance audits
- Assists in developing Revenue Integrity and Education Policies and Procedures
- Expert level of proficiency in Excel and