Revenue Integrity Analyst II

Job Details

Job Description

003584

PRIMARY FUNCTION:

Works to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices. Responsible for collaborating with Revenue Cycle and clinical departments to ensure accurate and thorough high level analysis of governmental and commercial payer regulations related authorization, coding and billing guidelines. Maintains current knowledge regarding coding guidelines, changing/billing regulations and regulatory agency activities.

ESSENTIAL FUNCTIONS: Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Primary clinical service-line liaison regarding payor guidelines, explaining regulatory requirements, and ensuring accountability and solid charge workflows for revenue integrity. Serves as the subject matter expert for clinical departments on issues related to revenue cycle. Identifies charge edit trends based on documentation, coding or charging issues and recommends workflow opportunities. Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. Develops processes to modify existing charge capture applications to reduce charge-related claim edits/rejections. Advises service-line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines. Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges. Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings. Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management. Assists in the development and implementation of effective charge master review, education and training.

EDUCATIONAL/TRAINING REQUIREMENTS:

Bachelors or Associates degree in Health Information Management, Business Administration, Accounting, Management, Healthcare Administration.

CERTIFICATES, LICENSES, AND REGISTRATION: Must hold and maintain one or more of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC). Applicable professional certifications from American Association of Healthcare Administrative Management (AAHAM) or Healthcare Financial Management Association (HFMA) preferred.

EXPERIENCE REQUIREMENTS: Five years experience in a hospital setting or within the healthcare industry strongly preferred. 1 - 3 years of experience related to auditing and/or coding is required. Knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Understanding of various reimbursement systems including IPPS, OPPS and fee schedule. Strong oral and written communication skills. Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations. Ability to document clinical workflows impacting revenue cycle. Strong written communication, presentation skills, and excellent customer service skills. Excellent organizational and project management skills. Strong time management, attention to detail, and follow through. Motivated individual who can mentor and inspire in a team environment.

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Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.