What are the responsibilities and job description for the Senior Revenue Integrity Analyst position at Prairie Lakes Healthcare System?
Senior Revenue Integrity Analyst
Workplace Details
Join our team and see why Prairie Lakes Healthcare System continues to be named a Top Rural and Community Hospital year after year. Be a part of our mission to make a positive difference in the health of the patients and communities we serve by delivering accessible, high-quality, affordable, and compassionate healthcare. Prairie Lakes Healthcare System is an independent, non-profit rural healthcare system serving 10 counties in northeastern South Dakota and west-central Minnesota.
POSITION SUMMARY
The Revenue Integrity Analyst is responsible for department charge capture processes and controls. This position acts as the liaison between Business Office and other revenue generating departments to ensure charging practices follow Federal and State billing regulations, while simultaneously ensuring appropriate, optimal reimbursement. This position is responsible for improving charge capture accuracy through workflow assessments, coordinating coding reviews, process improvements, and generating reports. The Revenue Integrity Analyst works collaboratively with leadership to assist in the development and implementation of process enhancements or initiatives that enhance charge capture accuracy and reimbursement. This position also works closely with Information Technology to complete and evaluate charge-related build by having a clear understanding of the charging workflows and triggers built within the electronic health record.
RESPONSIBILITIES
Charge Description Master (CDM)
Develops and maintains procedures and educational materials for department management regarding the following:
- CDM update and maintenance procedures for billing codes and pricing.
- Procedures for CDM “new item” requests.
- Department specific changes to charging/billing regulations affecting the CDM.
- Monitors Medicare charge requirements and maintains knowledge of all third-party payer guidelines, as well as federal and state regulations.
Charge Capture
- Daily review and resolution of work queues owned and/or monitored by Revenue Integrity to ensure that edits are resolved accurately and in a timely manner to support generation of a claim with all relevant charges posted when billing is initiated.
- Maintains working knowledge of CPT and HCPCS charging as well as all billing edits, CCI, OCE, MUE’s, and other relevant billing guidelines.
- Reports on trends, findings, and opportunities for improvement to management detailing findings and high-risk items that leaders should be monitoring, including missing, incorrect, and late charges.
- Performs department charge audits, assists departmental leaders with effective charge reconciliation processes, educates clinical departments on workflows causing billing edit resolutions, tracks problematic claim trends, and communicates/escalates issues along with recommended resolution pathways.
Benefits
Prairie Lakes Healthcare System offers comprehensive benefits for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 403(b)-retirement plan, and generous paid time off to maintain a healthy home-work balance.
Additional benefits for those qualifying include:
Prairie Lakes Healthcare System offers comprehensive benefits for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 403(b)-retirement plan, and generous paid time off to maintain a healthy home-work balance.
Additional benefits for those qualifying include:
- Flexible Spending Account
- Roth IRA retirement plan
- Employee Assistance Program for mental health
- Education Loan Program
- Community discounts including the Prairie Lakes Wellness Center
JOB QUALIFICATIONS
A minimum of bachelor’s degree in business, finance, accounting, healthcare, or related field strongly preferred or comparable amount of work-related experience.
Applicable professional certification through AHIMA (CCA) or AAPC (CPC A, COC-A) are highly desirable. May be requested to obtain professional credentials within 6 months of employment.
Certification as a Revenue Cycle Integrity Professional (CRIP) preferred. Certification preferred within 1 year of date of hire.
Proficiency in Excel and SQL queries.
Hospital and professional reimbursement, charge capture and charge master experience. Working knowledge of CPT & HCPCS coding guidelines. 3 years related experience preferred.
Prairie Lakes Healthcare System has a Drug Free Workplace Policy. An accepted offer will require a pre-employment background screening and reference check as a condition of employment.
