Revenue Integrity Charge Description Master Analyst

Job Responsibilities

• Performs in-depth analysis of charging workflows and other technical issues associated with Epic charging systems and applicable software.
• Defines and co-develops business requirements that allow for optimization of the system to enhance operational workflows.
• Understands and contributes to the process or enablement of collecting expected payment by ensuring accurate and compliant charge capture, coding and documentation outcomes.
• Supports the creation of educational materials for staff and process improvement needs.
• Researches and interprets CPT/HCPC coding and billing regulatory requirements to recommend and develop compliant solutions for CDM set up.
• Completes timely and accurate updates to the CDM that contribute to generating clean claims, enabling the collection of expected payments.
• Participates in ongoing coordination with revenue producing departments to ensure the accuracy of all CDM data elements and assists with resolution of CDM related revenue issues
• Conducts service line quality reviews leveraging reporting tools by evaluating process, functional and/or revenue gaps to determine resolution.
• Investigates, compiles, analyzes, accurately interprets, and validates data.
• Summarizes findings and opportunities identified in the data to support leadership decision making and executes corrective projects as needed.
• Provides continuous quality control and process improvement through work queue monitoring, variance checks, analysis, troubleshooting and detailed research.
• Develops, designs, and maintains visuals and/or reports.
• Acts as a point of contact/subject matter expert for charge application process and maintains a strong understanding of system functionality, software applications, and business workflow and objectives to appropriately interpret data and support leadership decision making.
• Maintains extensive knowledge of ICD-10-CM, CPT/HCPCs procedure coding and supports regular updates of CPT/HCPCS and regulatory changes, including the identification of codes that have been deleted, added, or replaced. Ensures that the appropriate system changes, supporting education, and proper communication is completed.
• Tests, identifies new conditions to test, and analyzes results of testing of new workflows and system functionalities to safeguard charging and revenue integrity.
• Outlines requirements for new analytic tools including necessary fields, appropriate calculations, data definitions, and integration points.
• Researches, documents, and facilitates resolution to charging issues reported by end-users.
• Develops and maintains relationships with key partners to explore and develop potential solutions to systematic issues, ensuring revenue integrity.
• Applies critical thinking knowledge to core functions to take action and ensure escalation of system problems and operational needs.
• Upholds timely and accurate work.
• Understands and adheres to Revenue Cycle’s Escalation Policy.
• Initiates judgment, makes decisions, and works autonomously under a minimal amount of supervision.
• Maintains knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting).

Required Qualifications

Education

• B.S./B.A. in applicable field. Four (4) years of applicable experience may substitute for a Bachelor’s degree.

Experience

• 3 years of applicable Revenue Cycle experience

Certification

• Epic Resolute Certification(s) in one or more of the following Epic applications within 1 Year
• Resolute Hospital Billing Charging or
• Resolute Professional Billing Claims or
• Resolute Hospital Billing Claims or
• Resolute Professional Billing Charging

Preferred Qualifications

Education

• B.S./B.A. in Business Administration, Health Care Administration, or applicable healthcare field.

Experience

• 5 years of applicable Revenue Cycle experience

Certification

• Registered Health Info Tech or
• Registered Health Info Admin or
• CHRI, or
• Certified Coding Specialist or
• CPC
• Epic Certification in Resolute Professional Billing or
• Epic Resolute Hospital Billing Charging

$77,729.60- $109,740.80 Annual