What are the responsibilities and job description for the Revenue Integrity Analyst - Full Time position at Titus Regional Medical Center?
Job Description: Revenue Integrity Analyst
Purpose of the Job
The Revenue Integrity Analyst helps the organization by optimizing the organization revenue and identifying and resolving issues that impact the accuracy and completeness of revenue cycle processes.
The Revenue Integrity Analyst will perform charge capture audits which are systematic processes of examining healthcare services from the point of patient registration or scheduling through to reimbursement. These audits encompass a comprehensive review of various processes associated with pre-visit readiness, such as patient eligibility, clinical documentation, coding, charge capture and charge reconciliation, billing, and reimbursement procedures, to mitigate revenue leakage. If navigated correctly, charge capture audits can unveil missing gems, which will improve processes, ensure compliance with regulatory guidelines, and improve overall financial performance.
This position requires a strong understanding of healthcare reimbursement methodologies, coding guidelines, regulatory requirements, and revenue cycle workflows. The Analyst will collaborate with most hospital departments (e.g., coding, billing, finance, clinical) to improve operational efficiency, enhance revenue capture, and ensure compliance with all applicable regulations.
Key Responsibilities
- Revenue Integrity Analysis & Improvement and System Optimization:
- Conduct in-depth analysis of key performance indicators (KPIs) related to revenue cycle performance, such as denial rates, days in accounts receivable, and reimbursement levels.
- Streamline charge capture processes through audits to improve operational efficiencies, reduce administrative burdens, and enhance overall productivity.
- Identify trends, root causes of inefficiencies, and areas for improvement within the revenue cycle.
- Develop and implement process improvement recommendations to enhance efficiency, accuracy, and productivity across the revenue cycle.
- Analyze and interpret data from various sources, including Epic, external billing systems, and payer policies.
- Coding and Charge Capture Review:
- Review medical records to ensure accurate and complete documentation that supports assigned diagnoses and procedures.
- Identify and communicate documentation gaps to physicians and other clinical staff.
- Conduct audits of coded accounts to evaluate the accuracy and completeness of assigned ICD-10-CM, CPT, and HCPCS codes.
- Identify and address coding errors, inconsistencies, and missed opportunities for capturing additional diagnoses and procedures.
- Collaborate with coders to resolve discrepancies and ensure accurate code application.
- Ensure adherence to regulatory standards and guidelines with payers, mitigating the risk of compliance violations and associated penalties.
- Payer Contract Analysis:
- Analyze payer contracts to identify potential reimbursement issues, such as underpayments, denials, and missed reimbursement opportunities.
- Work with contract managers to ensure that payer contracts are accurately interpreted and implemented.
- Assist in the identification and resolution of contract disputes with payers.
- Reporting & Analysis:
- Prepare and analyze reports on revenue cycle performance, including key performance indicators (KPIs), denial trends, and reimbursement rates.
- Present findings and recommendations to major stakeholders.
- Collaboration & Communication:
- Work closely with cross-functional teams, including coding, billing, finance, clinical, and IT, to ensure effective communication and coordination across the revenue cycle.
- Build and maintain strong relationships with internal and external stakeholders.
Qualifications
- Required:
- 4 years of experience in healthcare revenue integrity and cycle management.
- Preferred:
- Bachelor's degree in health information management (HIM), Business Administration, or a related field
- Coding certification (e.g., RHIA, RHIT, CPC) from AHIMA or AAPC.
- Knowledge of data analytics and reporting tools.
Key Skills & Abilities:
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Proficiency in relevant software applications.
- Strong organizational and time management skills.
- Detail-oriented and results-driven.
- Ability to work independently and as part of a team.
