Revenue Integrity Analyst II

JOB SUMMARY

This position is responsible for managing, coordinating, and implementing Charge Description Master (“CDM”) initiatives and processes. Ensures the overall integrity of the CDM. Maintains the CDM with a focus on accuracy, revenue cycle integrity, and compliance with third-party payor requirements. Assists clients with charge capture, billing, and compliance issues in accordance with government regulations. Facilitates maintenance of the CDM through additions, deletions, or modifications to line-item charges. Works independently; exercises discretion and independent judgment; makes decisions regarding the CDM after comparing and evaluating possible courses of action; formulates, affects, interprets, and implements management policies and operating practices; prioritizes and manages multiple tasks to meet deadlines; seeks guidance from management as needed to clarify assignments or requests, ask questions, or seek additional information.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Reviews CDM change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges; imparts knowledge to facilities regarding requested changes
• Identifies, researches, analyzes, review/analysis of pricing, resolves, and monitors CDM and charge capture processes to promote appropriate and consistent billing and coding practices.
• Provides guidance, communication, and education to multiple levels of personnel on correct billing, coding, and charge capture processes for hospital services.
• Assists with special projects related to price increases, special requests from clients, system conversions, or implementation of new CDM tools. May include other duties and/or special projects not listed.
• Assists in training new staff. Assists in coaching existing staff by building or enhancing individual skills or deficiencies. Provide one on one coaching or follow up training to staff as needed.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 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 recognize, research and correct charging/documentation discrepancies.
• Working knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues.
• Working knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• 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 affect on CDM and claims production

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Experience Required: 3-5 years of healthcare-related experience
• High School graduate or equivalent required .
• College degree preferred.
• Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, COC, CPC, CCS highly desirable

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel*
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments*

*May require these demands

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment
• Hospital Work Environment

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $51,626.00 - $77,438.00 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

Salary : $51,626 - $77,438