[Hiring] Revenue Cycle Integrity Analyst II - Coding and Compliance @Jefferson Health Plans

Role Description

The Revenue Integrity Analyst II position is a Full Time Day Shift Remote position.

• Works to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices.
• Responsible for collaborating with Revenue Cycle and clinical departments to ensure accurate and thorough high level analysis of governmental and commercial payer regulations related to authorization, coding and billing guidelines.
• Maintains current knowledge regarding coding guidelines, changing/billing regulations and regulatory agency activities.

Essential Functions:

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Primary clinical service-line liaison regarding payor guidelines, explaining regulatory requirements, and ensuring accountability and solid charge workflows for revenue integrity.
• Serves as the subject matter expert for clinical departments on issues related to revenue cycle.
• Identifies charge edit trends based on documentation, coding or charging issues and recommends workflow opportunities.
• Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• Serves as the service-line liaison between Revenue Cycle and clinical department administration regarding revenue, regulatory.
• Develops processes to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Advises service-line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines.
• Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges.
• Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings.
• Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management.
• Assists in the development and implementation of effective chargemaster review, education and training.

Qualifications

• Bachelor's or Associate’s degree in Health Information Management, Business Administration, Accounting, Management, Healthcare Administration.

Requirements

• Must hold and maintain one or more of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
• Applicable professional certifications from American Association of Healthcare Administrative Management (AAHAM) or Healthcare Financial Management Association (HFMA) preferred.
• Five years experience in a hospital setting or within the healthcare industry strongly preferred.
• 1 – 3 years of experience related to auditing and/or coding is required.
• Knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.
• Understanding of various reimbursement systems including IPPS, OPPS and fee schedule.
• Strong oral and written communication skills.
• Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations.
• Ability to document clinical workflows impacting revenue cycle.
• Strong written communication, presentation skills, and excellent customer service skills.
• Excellent organizational and project management skills.
• Strong time management, attention to detail, and follow through.
• Motivated individual who can mentor and inspire in a team environment.

Benefits

• Comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits.
• Access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.