Revenue Integrity Analyst, CDM

Job Description:

• Review pre-bill accounts flagged through Epic Revenue Guardian edits
• Enter missing hospital charges based on supporting medical documentation
• Evaluate charge capture opportunities and determine appropriate charge corrections
• Develop strategies for implementing new Revenue Guardian edits to reduce revenue leakage
• Provide analytical support related to third-party payer reimbursement and contract compliance
• Conduct quality control audits to ensure data/documentation integrity
• Trend accounts qualifying for Revenue Guardian edits and compile data by clinical department for education deliverables
• Serve as Subject Matter Expert to leadership on Revenue Integrity issues
• Prepare monthly reports and educational presentations for clinical departments and Revenue Manager teams
• Monitor data trends to validate documentation improvement initiatives and optimize charge capture
• Follow up with health team members to ensure accurate and complete medical-record documentation
• Collaborate with operational leaders to develop provider and service-line education strategies
• Use root cause analysis to correct negative trends and behaviors
• Review charges and payments for accuracy from contracted payers
• Manage the appeals process with assigned payers in hospital and clinic settings
• Identify revenue gains through reporting tools
• Perform other related duties

Requirements:

• Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree
• 3 years of experience related to coding required
• Coding certification (e.g. CPC, CCS, RHIA, RHIT) required
• In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements
• Revenue Cycle experience
• Strong oral and written communication skills
• Research-oriented with ability to critically analyze and reason large amounts of data
• Charge capture, reporting, and analysis experience preferred

Benefits:

• Equal Opportunity Employer
• Reasonable accommodation information and support for essential physical job functions