York, PA | Professional | Tracking Code: 86901

Revenue Integrity Analyst

James Kane
James Kane
Sr. Talent Acquisition Consultant

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:
    • At least one of the following certifications:
    • 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.

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Join our team of 20,000 strong working as one. Teamwork, collaboration, partnership—WellSpan Health is an integrated system designed to work as one to build healthier, stronger communities throughout central Pennsylvania and northern Maryland. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

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