Revenue Integrity Analyst Resume Samples

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S Jerde

Suzanne

Jerde

60521 Schmidt Harbors

Houston

+1 (555) 989 4013

60521 Schmidt Harbors

Houston

Phone

p +1 (555) 989 4013

Experience Experience

Chicago, IL

Revenue Integrity Analyst

Chicago, IL

Swaniawski LLC

Chicago, IL

Revenue Integrity Analyst

Working knowledge of multiple healthcare applications, including but not limited to SDK / Eclipsys, GE, SSI, 3M and CDM maintenance software
Presenting to upper management
Performs other duties as assigned
Project management
Creates measurement controls for monitoring and auditing file loads and downloads and insures consistency in application of processes
Serves as subject matter expert related to charging and billing issues and assists in developing and maintaining CDM related policies and procedures
Provide training and ongoing feedback, via report cards, to clinical staff to minimize errors

San Francisco, CA

Regional Revenue Integrity Analyst

San Francisco, CA

Terry-Gerhold

San Francisco, CA

Regional Revenue Integrity Analyst

Managed Care Contract Management
AR Aging – Reviewing and reporting findings to management, weekly, while tracking and trending changes
Time Management
Communicate Payer trends to management
Possess excellent knowledge of all PHI Protected health information guidelines of sensitive medical information
Review coding audits with auditor and vendor
Monitor claims/payments for timely billing/posting

present

Boston, MA

Revenue Integrity Analyst / Linthicum, MD

Boston, MA

Bode, Gusikowski and Lowe

present

Boston, MA

Revenue Integrity Analyst / Linthicum, MD

present

Under the direction of the Senior Revenue Integrity Analysts, CDM Coordinator and Department Managers, responsible for performing CDM audits with a focus on accuracy, maintaining compliance with regulatory agencies and assisting facilities with charge capture, billing and compliance issues
Communicates with UMMS departments to provide analytical and technical support regarding volume variances, charge capture, CDM accuracy, regulatory policies and procedures
Processes CDM additions, deletions and change requests in a timely manner while maintaining CDM compliance with local, state and federal regulatory agencies
Provides decision support to clinical departments and other customers regarding pricing, CDM concepts, HSCRC methodology and select reimbursement concepts
Distributes key compliance transmittals to clinical departments. Conducts annual audit on clinical department’s daily charge reconciliation processes to ensure methodology is compliant with University of Maryland Medical System standards
Participates in charge validation testing related to new system implementations and / or existing clinical / financial system upgrades. Responsible for maintaining detailed work papers and reporting results of charge validation testing to Department Manager
Prepares and submits audit findings and makes recommendations to Department Manager

Education Education

Bachelor’s Degree in Finance

Johnson & Wales University

Bachelor’s Degree in Finance

Skills Skills

Work with a team of great people
Rapid growth; stable company
Working knowledge of CPT/HCPCS codes, revenue codes
Working knowledge of medical terminology and abbreviations, and health care nomenclature and systems
Working knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines
Performs daily maintenance of the EAP chargeable database. Prepares exports and imports of the EAP database and data couriers activities. Performs all charge testing activities for New Department builds
Performs quarterly audits on the data elements in the chargemaster. Reviews Departmental front-end charge capture tools for accuracy. Assists in identifying charge capture opportunities in all revenue producing Departments. Troubleshoots complex account errors and assists in education for resolution to Revenue Manager(s)
Working knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance
Working knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement
Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity

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Revenue Integrity Analyst Resume Examples & Samples

Rapid growth; stable company
Performs quarterly audits on the data elements in the chargemaster. Reviews Departmental front-end charge capture tools for accuracy. Assists in identifying charge capture opportunities in all revenue producing Departments. Troubleshoots complex account errors and assists in education for resolution to Revenue Manager(s)
Bachelor’s Degree in Health Information Management, Finance, or similar
Strong Excel and Access skills
3 - 5 years of Revenue Cycle/Revenue Integrity experience Knowledge and experience with aspects of Medicare/Medicaid regulations, extensive understanding of CPT coding, and other third party billing requirements
RHIA preferred or related health care credential (e.g. Radiology technician, RN)
Requires detail oriented thinking and analytical skills. Must be able to work in a fast paced environment. The scope will be one of moderate complexity
Chargemaster/Charge Capture experience

Revenue Integrity Analyst w Resume Examples & Samples

Responsible for performing daily audit maintenance functions to ensure compliance, accuracy, and consistency of the chargemaster
Performs daily maintenance of the EAP chargeable database. Prepares exports and imports of the EAP database and data couriers activities. Performs all charge testing activities for New Department builds
Cash flow statement preparation
EPIC certification is a plus, but not required. If no EPIC Certification, must be willing to go get tested in near future

Revenue Integrity Analyst Resume Examples & Samples

Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity
Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third party payor requirements
Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents
Provides guidance, communication and education on correct charge capture, coding and billing processes to multiple clinical departments and facilities
Leads and participates in moderately complex projects related to revenue cycle initiatives
Collaborates with Compliance, Budget Office, Patient Accounts, Health Information Services, Internal Audit and other Revenue and Finance departments on revenue management initiatives
Analyzes billing error and denial data to identify root causes. Executes on work plans to correct identified deficiencies
Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. Executes on work plans to adapt systems and processes to accommodate changes
Three years experience in a hospital setting or within the healthcare industry preferred
Bachelor’s degree in finance or science or equivalent combination of education and experience
Applicable clinical or professional certifications/licenses such as CPC-H or AHIMA-CCS are highly desirable
Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
Financial analysis application skills, including database development and report generation
Advanced Excel and Access skills required
Well-developed, formal presentation skills
Comfort in presenting to and interacting with senior levels of hospital management and with physician leaders
Strong time management, attention to detail, and follow through
Well-developed research skills

Revenue Integrity Analyst Resume Examples & Samples

Provide education and support to all BHCS facilities and staff related to the Charge Description Master
Facilitate the review of the Charge Description Master quarterly, annually, and as needed to ensure compliance with federal guidelines
Provide communication and education to clinical departments regarding annual and quarterly CPT/HCPCS changes and additions
Provide support to CDM Analyst II and CDM Analyst Senior and perform other duties as assigned
Bachelor degree accredited college or university

Revenue Integrity Analyst Resume Examples & Samples

Strong interpersonal communication skills, effectively presenting information to management, facility groups, and individuals
Ability to respond in a professional manner to complex inquiries from a variety of sources
Strong analytical and research skills with various published resources, reference materials, internet resources, and other sources of information
Working knowledge of HCPCS/CPT codes, revenue codes
Working knowledge of revenue cycle processes
Ability to interpret a variety of state and federal regulations and determine affect on CDM and claims production
Working knowledge of computer systems and patient financial applications (i.e., Meditech, PBAR, SMS, etc)
Demonstrated proficiency in MS Office applications (Excel, Word, Access, Power Point)
Bachelor’s degree preferred; related experience may be considered in lieu of degree
Three or more years of healthcare-related experience
CDM or charge capture experience highly desirable
Travel may be required

Revenue Integrity Analyst Resume Examples & Samples

Strong interpersonal communication and presentation skills, effectively presenting information to management, facility groups, and individuals
Strong understanding of Revenue Integrity/Charge Description Master, its impact throughout the revenue cycle, and contribution to revenue management
Proficient understanding of expectations of patients, payors, and employees and how those expectations relate to complete, timely, and accurate work products
Proficient knowledge of HCPCS/CPT codes, revenue codes
Proficient knowledge of CMS guidelines
Strong knowledge of revenue cycle processes
Strong understanding of audit methodologies
Ability to respond to complex inquiries in a professional manner
Ability to read, review, analyze, and interpret a variety of state/federal regulations and managed care contracts to determine affect on claims production including multiple patient accounting systems, clinical/order entry systems, ancillary systems, and CDM
Proficient analytical and research skills to utilize appropriate reference materials, various published resources, internet resources, and other associated information sources
Working knowledge in MS Office applications (Excel, Word, Access, Power Point)
Five or more years of healthcare-related experience
Working knowledge of laws and regulations pertaining to healthcare industry required

Revenue Integrity Analyst Resume Examples & Samples

Interpersonal Skills – able to work effectively with other employees, patients and external parties
PC Skills – demonstrates proficiency in PC applications as required
Policies and Procedures – demonstrates knowledge and understanding of organizational policies, procedures and systems
Basic Skills – able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
Prior healthcare experience required
Prior clinical experience preferred

Revenue Integrity Analyst Resume Examples & Samples

Advanced knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement
Advanced knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance
Advanced knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines
Advanced knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues
Advanced knowledge of medical terminology and abbreviations, and health care nomenclature and systems
Advanced knowledge of CPT/HCPCS codes, revenue codes
Comprehensive knowledge of CMS laws, rules, and regulations governing CDM/CPT/Edits
Experience Required: 5+ years of healthcare-related experience
High School graduate or equivalent required
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments*
May require these demands

Revenue Integrity Analyst Resume Examples & Samples

Prepare summary materials and presentations for meetings
Support Director of Finance during monthly account close, including creating reports and data analysis
Assist in supporting the business needs

Revenue Integrity Analyst Resume Examples & Samples

Monitors government and commercial payers for updates and changes to billing requirements. Communicates and educates clinical and administrative staff on any actions required to comply with new regulations
Identify when rebilling is needed and coordinate the rebilling process with the Clinical & Fiscal Integration Team and Patient Financial Services
Collaborates with the clinical departments and enterprise Information System team to ensure that the appropriate ancillary/clinical modules are updated appropriately
Audits charges being captured by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended
Minimum five years health care with three years chargemaster or billing or coding
Experience with chargemaster maintenance or proficient knowledge of chargemaster components (CPT, HCPCs, Revenue Codes)
Experience using Craneware Charge Master Toolkit and Meditech Patient Accounting
Knowledge of CPT-HCPCS, third party reimbursement methodologies, and revenue cycle process
Expert knowledge of inpatient and outpatient billing requirements, coding guidelines and CMS Medicare reimbursement methodology
Must be flexible and be able to adjust in changing environments, including traveling to each Steward facility
Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others
Ability to respond to complex inquiries in a professional and efficient manner
Proficient in using Microsoft Excel, PowerPoint and Word

Revenue Integrity Analyst Resume Examples & Samples

Responsible for the oversight and updating of the Epic Charge Description Master and associated functions within the Revenue Integrity Department of RCM. Provide support for implementations, ongoing maintenance, and optimization of Epic CDM and charging functions
Responsible for the remediation of assigned Epic system CDMs, charge capture methods, and error work queues
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. Collaborate with managerial and supervisory staff to ensure regulatory billing with correct coding on accounts
Maintains a working knowledge of revenue cycle process and Epic tools (e.g., work queues, reports, etc.) to aid in the implementation of regulatory standards that assist the health system in cash production while accurately complying with billing guidelines. Monitor compliance with corporate, federal, and state guidelines
Maintains timely turnaround of all CDM requests in accordance with established Service Level Agreements (SLA) or regulatory deadlines. Participate in ongoing coordination and resolution of revenue issues as they arise
Analyzes reports and works queues to determine areas of improvement and determine appropriate plan of action. Disseminates CMS updates to health care providers as they relate to billing for drugs, implantable and/or other pass-through eligible items, ensuring the necessary changes are made to the CDM within the time frame for accurate and compliant billing
Remains current with updated coding and billing regulations
Develops and maintains strong working relationships with internal and external customers
Maintains high productivity and quality with minimal supervision
Charge capture experience highly desirable

Revenue Integrity Analyst Resume Examples & Samples

Drives and coordinates hospital wide initiatives to ensure compliance of governmental billing regulations
Complete tasks for specific patient accounts, service lines, or departments to ensure appropriate statement of revenue through audits, denial/write off management, charging process improvements
Approves requests for changes, additions, deletions to the Charge Master
Monitors and implements hospital and department charging policies
Analyzes revenue impact related to charge master changes
Provides analysis for annual price increase and ad hoc revenue neutral analysis
Service as a lead in project teams to implement process improvement initiatives
Executes annual regulatory compliance audits

Revenue Integrity Analyst Resume Examples & Samples

1 year of CDM experience
Certified Professional Coder (CPC)
Preference given to those in financial or medical orientation
2 years in a Medical/Clinical office setting
Knowledge of and familiarity with medical terminology
Knowledge of human anatomy and physiology
Ability to create and manipulate spreadsheets
Must have the ability to develop and lead teams toward stated objectives

Senior Revenue Integrity Analyst Resume Examples & Samples

At least five years minimum recent experience in healthcare finance, revenue cycle management, CDM maintenance or related field. Experience in an Academic setting preferred
Must have revenue code, CPT and HCPC coding knowledge
General understanding of multiple reimbursement systems including IPPS, OPPS, and Fee Schedule
Possess effective oral and written skills
Ability to interpret and implement regulatory standards
Working knowledge of multiple healthcare applications, including but not limited to SDK / Eclipsys, GE, SSI, 3M and CDM maintenance software
Well developed research skills
Possess effective time management skills to permit handling of large workload
Dual Hospital and Professional Coding Certification(s) (CPC, CPC-H, CCS, CCSP) preferred

Revenue Integrity Analyst Resume Examples & Samples

Bachelor's degree (or equivalent work experience)
At least three years minimum recent experience in healthcare finance, revenue cycle management, CDM maintenance or related field. Experience in an Academic setting preferred
Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff
Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access
Knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD-9, etc.) inclusive of associated edits such as NCCI

Senior Revenue Integrity Analyst Resume Examples & Samples

Ability to work independently and possess effective time management skills to permit handling of multiple projects and/or tasks
Extensive knowledge of CPT, HCPCS, and Revenue Codes required
Solid undestandig of multiple reimbursment stems inluding IPPS, OPPS, and fee schedules
Excellent analytical skills to identify root causes to issues and propose solutions
Solid skills in interpreting and implementing regulatory standards
Proficient with Windows software, including but not limited to Micosoft Windows, Outlook, Excel, and PowerPoint
Possess excellent verbal and written communication skills
Working knowledge of multiple healthcare applications, including but not limited to SDK / Eclipsys, GE, EPIC and CDM maintenance software

Revenue Integrity Analyst Resume Examples & Samples

A minimum of 3 years of experience working in the healthcare industry
Some travel will be required within Western Montana Service Area
Bachelor’s degree in business, healthcare administration or related field or equivalent experience
Three years clinical experience
Experience/Training with Epic charge capture, charge master mapping and work queue management
Knowledge of CPT, HCPCS, and ICD coding

Revenue Integrity Analyst Resume Examples & Samples

Analyzes and approves audit requests received from insurance companies
Gathers and analyzes data. Documents findings, provides impact and cost, benefit analyzes and recommends specific system changes
Provides completed audit detail bill to logging for reconciliation
Maintains tracking of insurance defense audits and coordinate obtaining the medical record
Supports statistical data in the audit database
Analyzes information flows to ensure greater integration of functions within department
Validates and maintains accuracy and integrity of data

Revenue Integrity, Analyst Resume Examples & Samples

Working knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement
Working knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance
Working knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines
Working knowledge of CMS guidelines
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency
Ability to establish and maintain effective working relationships as required by the duties of the position
Working knowledge of CPT/HCPCS codes, revenue codes
Ability to interpret a variety of state and federal regulations and determine effect on CDM and claims production
Experience Required: 3-5 years of healthcare-related experience
Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, COC, CPC, CCS highly desirable
Ability to travel*

Revenue Integrity Analyst Resume Examples & Samples

Provides system reports and database extractions relative to revenue cycle and financial operations; provides research and analysis related to reports, initiates system changes, acts upon (as appropriate) and monitors output to ensure relevant, timely, accurate, and compliant data/results. (50%)
Provides support to internal and external departments by assisting with process automation and maintaining system compliance and data integrity. Identification and documentation of system and process data issues as well as revenue cycle trends on a continuous basis. Accurately reports departmental and revenue cycle indicators defined by management within specified time frames. (25%)
Completes special projects and assignments as required collaborating with management, information services, project leadership/members, users and external customers to ensure project goals are realized. (20%)
Participates in and/or coordinates system enhancements ensuring system integrity through appropriate testing, validation, and implementation. Communicates and serves as a resource related to system enhancements. (5%)

Revenue Integrity Analyst Resume Examples & Samples

Bachelor's degree in Business Administration or Health Care Administration; four years of relevant work related experience in a health care setting can be substituted in lieu of a degree
Three years of directly related work experience with Bachelor's degree or seven years of directly related work experience without a Bachelor's degree
Preferred: Experience in a Health Care setting, revenue cycle management, EPIC, and professional coding and billing
Preferred: Certified Coder
Understanding of clinical and multidisciplinary operations, EPIC, Revenue Cycle Management, Professional Coding and Billing
Understand basic math functions such as multiplication, division, percentages and the interpretation of those results
Ability to evaluate and flowchart processes

Revenue Integrity Analyst Resume Examples & Samples

Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives
Obtains data extracts from specific system to support audit function. Validates data by researching anomalies and cross-referencing data with other systems
Coordinates with Medical Auditor and Liaison to analyze charge capture and reconciliation data and provide trending information on a monthly basis
For special audits (e.g. private insurance), within two weeks of receipt of audit spreadsheet, add additional fields required to validate payments, previous refunds and contract rates in order to confirm appropriateness of refund request. Research account data variances and finalize adjusted refund amound
Serves as technical support for Revenue Integrity staff on Microsoft applications
Assist with identification, reporting, analysis and resolution of information system problems
Provides back-up resource for report analysis and account corrections. Maintains knowledge of reports by working collaboratively with Senior Systems Specialist in completion of one report each month
Bachelor's Degree in Business Administration or Healthcare Finance
Master’s degree (MHA or MBA), preferred
Five (5) years of experience as financial analyst in hospital decision support or database management. Hospital and finance background strongly encouraged, preferred
Financial and Accounts Receivable experience in hospital environment. Quantitative and financial analysis skills; time management skills with ability to prioritize projects to meet deadlines. Competent in Microsoft office suite applications
Database management and statistical analysis, preferred
Epic Clarity Certification, preferred

Revenue Integrity Analyst / Linthicum, MD Resume Examples & Samples

Distributes key compliance transmittals to clinical departments. Conducts annual audit on clinical department’s daily charge reconciliation processes to ensure methodology is compliant with University of Maryland Medical System standards
Completes necessary updates to encounter forms and facilitates changes to ancillary order entry systems to clinical departments, ITG, PFS or other appropriate individuals and monitors acknowledgment of implementation
Participates in charge validation testing related to new system implementations and / or existing clinical / financial system upgrades. Responsible for maintaining detailed work papers and reporting results of charge validation testing to Department Manager
Prepares and submits audit findings and makes recommendations to Department Manager
Communicates with UMMS departments and front line management personnel to provide analytical and technical support regarding hospital volume changes and helps resolve issues identified. Assists the clinical department managers in understanding variances from budget and documenting new services that impact encounter forms, charge capture processes and changes to the CDM
Analyzes reports to determine areas of improvement or in need of further investigation; determines appropriate plan of action and works with department to rectify any charge capture problems /questions
Compiles financial and statistical reports of a specific nature in accordance with departmental procedures. Prepares weekly, monthly and annual volume reports and other routine management reports; includes analyzing revenue center detail to determine the accuracy of those reports
* Employee Benefits ***
Two years progressively responsible financial planning, financial analysis, budgeting, managed care or accounting experience, or the educational equivalent, is preferred
Healthcare-related finance background is preferred
Minimal knowledge of Medicare and HSCRC regulations is preferred
Minimal knowledge of medical terminology and use of CPT (Current Procedural Terminology) reference manuals is preferred
Proficient knowledge of spreadsheets (i.e., Lotus, Microsoft Excel), databases (i.e., Microsoft Access), word processing programs (i.e., Microsoft Word), graphic/specialty and other finance-related software programs
Exhibits effective verbal and written communication skills that are necessary in dealing with a variety of healthcare and finance professionals including senior management staff
Demonstrates ability to tactfully provide support to all levels of staff and management while maintaining required degree of confidentiality and purpose
Ability to judge the level of confidentiality of information / activities involved in and to exhibit integrity in use of dissemination of such information
Ability to develop and evaluate complex financial data via use of computer analysis
Developing organization and problem-solving skills and emerging team leadership skills are required to develop and implement efficient work processes. Ability to work in a stressful environment
Ability to maintain working knowledge of the Craneware Charge Master Toolkit software, hospital specific Patient Accounting Systems, how it relates to charge master compliance objectives and their application to the various hospitals within the University of Maryland Medical System. Keeps current on Craneware system updates and enhancements

Revenue Integrity Analyst Resume Examples & Samples

Create measurement control to ensure sustainability and repeatability
Regular and consistent contact with Revenue Reconciliation Leaders, state contacts and eligibility operations on all eligibility and revenue related projects / issues and discrepancies
Monitors all process changes that may affect revenue and will adapt controls accordingly
Participates in cross functional changes / improvements between functional areas including processes that impact multiple markets
Monitors and measures results of processes between enrollment and revenue team
Insures that financial operations processes support accurate collection of premium
Monitors all cross functional transactions, including IT file transactions, to insure consistency in application and accuracy in handoffs
Creates measurement controls for monitoring and auditing file loads and downloads and insures consistency in application of processes
Insures the reconciliation of member eligibility to revenue receipt for each member, each month. Communicates issues identified through RAM reporting or other sources to identify root cause
Serves as a key resource on complex and/or critical issues
Performs complex conceptual analyses
Provides explanations and information to others on the most complex issues
Uses pertinent data and facts to identify and solve a range of problems within area of expertise
Prioritizes and organizes own work to meet deadlines
Demonstrate strong communication skills (verbal, written)
Demonstrate and apply understanding of health care industry trends and their drivers
Medicaid, government or health plan experience
Proven skills in reporting and analysis

Revenue Integrity Analyst Resume Examples & Samples

Maintains working knowledge of patient registration/account creation processes and appropriately advises others of processes to optimize claim submission and reimbursement
Performs patient account maintenance including, but not limited to, crediting, manual charge entry, account reconciliation and merges
Resolves all forms of denials and maintains patient billing work queues in a timely manner, coordinating efforts with appropriate parties or departments
Maintains industry knowledge of payer policy, including but not limited to; Medicare, Medicaid, Blue Cross and Champus. This includes knowledge of CPT coding, various edits, and modifiers
Develop and train users in processes to support payer policy and ensure compliance
Develops positive relationships with key revenue cycle and operations departments including but not limited to Laboratory, Diagnostic Imaging, Access, Insurance Verification, Healthcare Information Management, Patient Financial Services and Professional Billing
Coordinates and maintains accurate files of invoices, requests for information changes, and other supporting documents
Reviews pricing structure and creates and maintains resource materials for internal and external customers. Serves as the principal resource for pricing questions, pre-authorizations and Advance Beneficiary Notice (ABN) processes
Maintains dashboard of financial activity, reviewing and reporting anomalies in a timely fashion. Provide routine reports to the area’s Quality committee and others as requested
Serves on task forces or special projects as requested
Functions in a role as a leader, supporting team goals, process improvement and the overall professional and compassionate care of patients
Three (3) to five (5) years experience in healthcare billing, denials, and account reconciliation
Three (3) to five (5) years experience in a clinical healthcare environment
Bachelor’s degree in clinical healthcare field or Information Systems
Certification in coding for Laboratory and/or Diagnostic Imaging

Revenue Integrity Analyst Resume Examples & Samples

Performs Financial/Revenue Modeling
Performs hospital on site visits and training as needed
Assists National Director of Revenue Integrity with special projects as needed
Prior hospital revenue cycle experience required, including hospital business office experience
Minimum 2-5 years experience with McKesson PCON
Minimum 2-5 years experience with McKesson Star or Cerner
Microsoft Office proficiency required, must be proficient in excel
Microsoft Access knowledge preferred
Ability to communicate clearly and effectively
Solid competencies in assessment, critical thinking and analytics
Prior Financial/Revenue Modeling experience preferred

Revenue Integrity Analyst Resume Examples & Samples

Education: A Bachelor’s Degree, preferably in Healthcare Administration, Business, Finance, or computer programming and two (3) years’ experience within the revenue cycle. Experience above and beyond minimum requirement will be consisted in lieu of education
Certification: Preferred certification as a medical coder through AHIMA (CCA, CCS, CCS?P) or through AAPC (CPC?A, CPC, COC, CIC) and/or preferred certification as a Pharmacy Technician CPhT
Experience: Knowledge of revenue cycle processes, medical billing (preferably 3 years’ experience) and coding processes, CPT, HCPCS, ICD?9/10, NCCI edits, Medicare LCD/NCD, basic accounting principles, quantitative decision making and process analysis through formal education or two years of work experience in the revenue cycle. Meditech experience preferred
Advanced level of communication, interpersonal, problem solving and organization skills in order to maintain a high level of production and accuracy in an extremely task driven environment
Proficiencies: Advanced computer analytical skills to create and maintain reports and provide analysis (1) in support of project initiatives and (2) to resolve complex charging/revenue issues (Microsoft Excel, Word, Outlook, etc.). Ability to utilize LEAN process innovation techniques for root cause analysis

Revenue Integrity Analyst Resume Examples & Samples

Communication- communicates clearly and concisely, verballyand in writing.This includes utilizing proper punctuation, correct spelling and the abilityto transcribe accurately
Customerorientation- establishes and maintains long-term customer relationships, buildingtrust and respect by consistently meeting and exceedingexpectations
Interpersonalskills - able to work effectively with other employees, patients and external parties
PC skills- demonstrates proficiency in MicrosoftOffice applications and others as required
Basic skills- demonstrates ability to organize, perform and track multipletasks accurately in short timeframes, have ability to work quicklyand accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player,adaptability, analyticalandproblem solvingability and attention to detail and able to perform basic mathematical calculations, balanceand reconcile figures, punctuateproperly, spell correctly and transcribe accurately

Revenue Integrity Analyst Resume Examples & Samples

Maintains knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards
Actively participates in creating and implementing improvements to achieve clinical, satisfaction and/or efficiency outcomes
Continuously works to identify revenue opportunities. Participates in projects to improve process efficiencies and revenue capture
Performs in depth analysis and reporting to support the needs of internal customers
Maintains reporting tools and or dashboards to track key indicators, including peer benchmarking
Analyzes large data sets to identify revenue opportunities and prevent revenue loss. Maintains ongoing predictive charge models
Utilizes current payer contract terms and payer mix information to estimate net revenue calculations. Monitors coding and billing changes that may affect revenue and assesses contract terms and methodologies to ensure maximum reimbursement
Troubleshoots and optimizes and functional issues that may arise. Defines the requirements for the development of education and training programs

Regional Revenue Integrity Analyst Resume Examples & Samples

AR Aging – Reviewing and reporting findings to management, weekly, while tracking and trending changes
Managed Care Contract Management
Responsible for monitoring billing, collections and reimbursement, review and report findings
Review coding audits with auditor and vendor
Monitor claims/payments for timely billing/posting
Communicate Payer trends to management
Maintains strict confidentiality in accordance with HIPAA regulations and company policy
First and second level appeals, as needed
Requires a thorough knowledge of the necessary practices and procedures for Professional Billing, Facility Billing, Insurance Verifications, Third Party Insurance coverage, Medicaid and Medicare follow up, Insurance denial review and overturn procedures
Must be thorough, efficient, understanding and maintain a pleasant manner with patients and staff
Possess excellent knowledge of all PHI Protected health information guidelines of sensitive medical information
Two years of billing and health care experience required
Accounts Receivable experience preferred
Ability to read, analyze and interpret insurance carrier Explanation of Benefits
Demonstrate excellent customer service skills when communicating with co-workers, physicians, peers and clients
Understanding of CPT, ICD-10 and HCPCS preferred
Familiarity with DDE preferred
Must be able to handle confidential situations and account information in accordance with HIPAA guidelines
Willingness and ability to learn new tasks

Revenue Integrity Analyst Resume Examples & Samples

Reviews and/or processes changes, addition and deletion requests for CDM updates
Follows HELIOS required change control processes for all updates/changes needed
Participates in CAB call for Service Now Tickets submitted by Clinical and/or Operational departments. Routes/assigns Service Now tickets to responsible CDM team members based on assigned departments
Serves as technical resource for assigned clinical or business departments throughout HFHS. Responsibility includes, but is not limited to, the assessment of optimization efforts to meet system goals including patient safety, quality of care, charge capture and improving operational efficiencies
Collaborates with EPIC Application teams, Reimbursement, Compliance, and SMEs to maintain/update/test the CDM and appropriate EAP records and their links to these records for pricing and fee schedule maintenance
Supports timely implementation of coding updates (CPT/HCPCS), periodic UB Revenue Code updates, modifier revisions and regulatory updates to CDM. Assists CDM Team with communications to Clinical End Users, Revenue Integrity, Reimbursement, IT, HIM and others (as needed) when coding changes may impact net reimbursement, gross charges, productivity or internal processes
Analyzes and processes charging and rate errors within EPIC Work Queues as well as other claim edit or charge review issues that occur
Coordinates distribution of monthly CDM listings and reports to MedAssets and other users. Runs Jxports lists. Creates/runs other EPIC/CDM reports as needed
Reviews and requests changes to preference lists (charge navigators)
Performs a variety of duties within EPIC including, but not limited to, creation of EAPs in POC (Proof of Concept) environment and test PB custom codes in POC or TST and updates fee schedule rates in POC for CDM Manager’s review
Provides quality control check and audits that expected CDM changes have properly moved from test into the production environment
With the CDM Manager and CDM Coordinator, collaborates with appropriate HELIOS application team or Subject Matter Experts (SME) to maintain the various table files for providing accurate CPT/HCPCS and revenue codes within EPIC which are responsible for providing accurate CPT/HCPCS codes and revenue codes based upon multiple payer requirements
Adheres to HELIOS Service Level Agreements related to EPIC
Analyzes legislation and regulations, reviews and interprets records, newsletters, bulletins, (billing and remittance) to comply with third party regulations. This includes knowledge of Medicare/Medicaid regulations as well as understanding of managed care contracts
Actively participates in ongoing monitoring process to identify billing problems related to the CDM to include: evaluation of the accuracy of interface functionality, quarterly audit of the appropriateness of UB04 formatting for major payers and confirmation of the accuracy of departmental charge capture tools (charge screens, charge sheets, etc.)
Participates collaboratively with Revenue Integrity team in the development, execution and follow-up of education programs for Administration, Managers and Staff on all issues related to the charge master and charge master related processes
Establishes and maintains effective working relationships with Nursing, Physicians, other Clinical Staff, Information Services, HIMS and PFS to facilitate expeditious resolution of coding and billing issues related to the functionality of the CDM file and related interface processes
Participates actively in team development, achieving dashboards, and in accomplishing department goals and objectives
Associate’s Degree Required, Bachelor’s Degree Preferred
Coding certification (CPC, COC, CCA, CCS, RHIT) Preferred
Current Charge Description Master experience is highly preferred
Previous Billing experience (professional and/or hospital) is highly preferred
Previous Clinical experience including RN, NP, RT, etc. a plus

Senior Revenue Integrity Analyst Resume Examples & Samples

Bachelor’s Degree in Accounting, Finance or Related Field
Master’s or CPA Preferred
Minimum 5 years experience in financial analysis. Healthcare experience preferred. Previous experience managing complex projects is preferred

Revenue Integrity Analyst Resume Examples & Samples

Become the subject matter expert on revenue cycle operations overseeing all aspects of the charge capture process for rheumatology injections, interventional radiology, ultrasound, and the Infusion Departments
Daily review of Infusion and drug administration charges to make sure they were entered correctly and timely
Reviews Medication Administration Record documented by nurses to ensure they support the charges posted. Reviews completed in timely basis and deficiencies reported to nurse management
Daily review of interventional radiology and ultrasound charges to make sure they were dropping correctly and timely. In addition, ensuring that the documentation supports the charge
Conduct detailed data analysis to identify trends, root causes and areas for improvement
Maintain a comprehensive charge selection manual for the Infusion department
Provide training and ongoing feedback, via report cards, to clinical staff to minimize errors
Collaborate with Revenue Cycle Operations to resolve any billing discrepancies
Continuous reviews of charge capture process to ensure compliance with Medicare guidelines
Work with various departments in maintaining a daily billing reconciliation report of productivity of Infusion treatments and charges. Ensures all necessary charges are reconciled on a daily basis
Minimum of three years of related experience or an equivalent combination of education and experience
Proficient in the use of productivity-based computer software (MS Office)
Familiar with medical terminology and hospital medical billing guidelines

Revenue Integrity Analyst Resume Examples & Samples

Proficiency in the use of personal computers and Microsoft Office for communication, internet access, database development, financial analyses and report generation
Experience and general knowledge with medical terminology and anatomy/physiology
Detail oriented with strong organizational, analytical, problem-solving, prioritization, time-management, and multi-tasking skills
General understanding of the various charging and coding systems in Healthcare
Ability to demonstrate continuous personal development and improvement
Ability to develop and lead teams toward stated objectives and goals
Understand general QIP principles, have the ability to report key improvement data, and show progress towards department goals

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