Employment Spot

Job Description

Patient Account Services
Revenue Integrity Analyst
Position based at Westside Regional Medical Center

JOB DESCRIPTION
JOB TITLE: Revenue Integrity Analyst
GENERAL SUMMARY OF DUTIES â€" Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Maintain the integrity of facility Charge Description Master (CDM) and Revenue Integrity Systems Program. Maintain the integrity
of all Ancillary Department systems related to billing and revenue. Position will serve as liaison between Administration, the Orange Park PAS and Ancillary Department Directors regarding revenue and compliance issues. Position will coordinate all retrospective, concurrent, patient complaint and external billing audits. Provide monthly audit results. Develop and coordinate educational in-services to the Business Office staff and Ancillary staff related to charging and billing issues. Review denial trends for documentation or charging issue opportunities. Review high charge stays/procedures for charging accuracy. Ensures web tool (unbilled) items are addressed properly and timely. Serve as primary contact for all charge-related PAS inquiries and issues.

SUPERVISOR â€" Regional Revenue Integrity
SUPERVISES - N/A

DUTIES INCLUDE BUT ARE NOT LIMITED TO
• Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRT Medical necessity, Correct Coding Initiative, Outpatient Code Editor(OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertise’s.
• Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record
• Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership.
• Reviews all BHL, Mutual, FCSO, PAS Billing Compliance correspondence and adheres to all guidelines
• Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems:
• Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues.
• Member of facility FECC Committee; reports charging issues, etc.
• Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls per HCA Requirements.
• Perform other related functions as assigned

Job Requirements

KNOWLEDGE, SKILLS & ABILITIES
• Excellent communication skills both verbal and written
• Good interpersonal skills
• Able to establish good customer relationships with trust and respect.
• Able to travel as needed
• Computer skills: navigation and edit resolution through various Web based systems, Ability to use email, Excel, Word.

EDUCATION
• Associate Degree in Nursing or LPN required. Registered Nurse preferred.

EXPERIENCE
• Healthcare experience required

CERTIFICATE/LICENSE –
• Current State of FL licensure as a Registered Nurse or LPN

PHYSICAL DEMANDS/WORKING CONDITIONS - Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a
keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people.
OSHA CATEGORY – The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their
employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.