[Hiring] Revenue Integrity Analyst @Highmark Health

Role Description

This position performs reporting and analysis of the revenue cycle for monitoring and problem resolution; assists staff with internal and external system issues, audits and questions relative to accounts receivable; acts as a primary liaison with other parties to resolve system issues and ensure compliance with all regulations; participates in department/system initiatives involving testing and other activities to ensure overall goals are met. Collaborates with facility/department leadership on a continuum basis. Activities include:

• Analysis (including root cause)
• Monitoring & auditing
• Reporting & education with regards to Revenue Cycle training & problem resolution with all levels of leadership including physicians, service line VP's, CAO's, CFO's, etc.
• Establishing and implementing appropriate internal controls to achieve complete and accurate documentation & billing processes
• Collaborating and helping to optimize clinical documentation through analysis and prioritized evaluation
• Assisting with maintaining the integrity of the CDM (charge description master) and the software program

Qualifications

• Minimum: High School/GED
• 1-3 years in hospital or physician revenue cycle, billing, coding or billing
• Preferred: Bachelor's Degree in Business, Healthcare or related field
• 1 year in Project Management
• 1 year in an Epic-billing environment

Requirements

• Responsible for financial, statistical and operational projects
• Present detailed analysis of A/R performance and other financial reports and related outcomes/trends
• Research and validate clinical data used to support medical necessity of billed services
• Conduct quality assurance reviews of various billing components, technical requirements, supporting processes, systems and required documentation
• Review outcomes with a wide array of people (i.e., Practice/clinical Directors, Practice/clinical Managers, senior leadership, Coding Manager, hospital case management, managed care contracting and RCC management) and influence adjustments to current facilities, practices
• Perform ad hoc consultative research and coordination on current issues of Revenue Cycle regulatory risk including medical necessity denials
• Identify a framework of continuous improvement to accomplish programmatic goals
• Facilitate meetings both internal and external
• Work collaboratively with system compliance leadership to coordinate and manage RAC and payer audit appeals
• Serve as the Revenue Cycle regulatory liaison between the Practice and the RCC for efficient management of accounts receivable
• Provide ongoing guidance, training and support to practices and departmental Revenue Cycle staff
• Monitor and audit Revenue Cycle issues
• Research regulatory concepts for gaps and opportunities to improve Revenue Cycle compliance
• Identify under- and over-charge items for immediate resolution by the provider/practice
• Conduct assessments both desk level and on site
• Provide ongoing education to departments, practices and RCC staff concerning practice management system, coding and regulatory complexities
• Develop and implement action and educational plans to target resolution of Revenue Cycle issues
• Collaborate with Compliance, Budget Office, Patient Accounts, Health Information Services, Internal Audit and other Revenue and Finance departments on revenue management initiatives
• Develop and maintain a Quality Audit program and associated reporting

Benefits

• Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations
• The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets