Revenue Integrity Analyst

Leola, PA | Professional | Tracking Code: 70520

Job Description:

Under the general supervision of the Director of Revenue Integrity, is responsible for researching, identifying charge errors or omissions by reviewing documentation through work queues or audits. This role will educate and collaborate with clinical staff on proper charging techniques. Helps to identify chart discrepancies in documentation and reports findings to management. This position works on special revenue projects as directed by the Revenue Management leadership.

 

Duties and Responsibilities

 

  1. Identifies, analyzes and reconciles charging errors or omissions by reviewing documentation and educating staff on proper charging to reduce errors.
  2. Consults with departments throughout the system on charge capture.
  3. Completes assigned Epic work queues, which are moderately difficult in nature, requiring a broad knowledge of charge capture and revenue integrity theory and principles.
  4. Conducts reviews/audits of medical records documentation to identify potential charging and billing issues including lost revenue opportunities; prepares reports based on findings to management.
  5. Works collaboratively with Epic Project One to assess validity of proposed new revenue guardian edits.
  6. Serves as department point person for monitoring clinical charge review work queue for timely completion.
  7. Evaluates supplies being added in Lawson for the appropriate HCPCS coding assignment and adherence of WellSpan’s supply policy.
  8. Helps facilitate charge entry of external charge invoices that WellSpan receives related to inpatient hospitalizations.
  9. Stays current with CMS, AHA & state coding, charging and reimbursement guidelines.
  10. Other duties assigned to meet expectations that would include root cause analysis, research of complex charging issues,

 

 

Qualifications

  • Notes:
    • Other combinations of formal education, training and experience may be considered.

 

  • Minimum Experience:
    • 4 years of coding and reimbursement experience

 

  • Minimum Education:
    • Diploma or GED

 

  • Minimum Field Of Expertise:
    • Inpatient/outpatient coding systems and coding compliance

 

  • Required Certification:
    • Certified Procedural Coder (CPC), Certified Outpatient Coder (COC) or
    • Certified Coding Specialist-Physician (CCS-P)

 

  • Skills:
    • Working knowledge of medical terminology, anatomy, physiology, health care facility CPT/HCPCS codes, UB-04 revenue codes and denials. Good knowledge of hospital financial operations including charge description, and revenue cycle processes. Respectable knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing. Exceptional analytical and problem-solving skills in order to define problems, collect data, establish data, establish facts, and draw valid conclusions. Extensive knowledge of Best Practice Standards of Coding and identification of reliable compliant reference sites and/or materials. Strong interpersonal skills. Excellent written and oral communication skills. Must be able to work independently without supervision.
James Kane
James Kane
Sr. Talent Acquisition Consultant
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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,600 physicians and advanced practice providers, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 20,000 employees and 200 patient care locations. WellSpan is a charitable, mission-driven organization committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

Welcome. Respect. Value.

Wellspan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Quality of Life

Lancaster City was the capital of Pennsylvania from 1799 to 1812. Today, Lancaster County includes a vibrant downtown business district, desirable suburban neighborhoods and sprawling agricultural farms. Life in Lancaster County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, an independent professional baseball team, fine dining and more. When visiting Lancaster, one can't help but recognizing the influence of the Pennsylvania Dutch — farm-to-table and beyond.

Conveniently located in southcentral Pennsylvania, Lancaster is within an easy commute to major cities and has ready access to public transportation. Residents can find local employment in healthcare, tourism, public administration, manufacturing, and both professional and semi-professional services. (Patient population: 535,000)