[Hiring] Senior Revenue Integrity Analyst @University of Texas Medical Branch (UTMB)

Role Description

Develops and tracks meaningful metrics and key performance indicators for SOM and Health System departments to ensure accurate and optimal revenue capture and reimbursement. Responsibilities include interpretation of complex metrics and reporting, and regular communication with departments and external stakeholders on performance and improvement areas. Utilize appropriate tools to support charge capture, revenue reconciliation, denial management, and payment validation. Serve as subject matter expert to Revenue Integrity Analysts.

Qualifications

• Bachelor’s degree or equivalent in Finance, Business Administration, Health Care Administration, Nursing, or related field.
• Four (4) years of related experience.
• Professional billing experience (preferred).
• Proficiency in Microsoft Office Suite, including Excel and PowerPoint (preferred).
• Experience delivering presentations to internal or external stakeholders (preferred).

Requirements

• Coordinate with report writers to develop department-specific reporting on revenue and reimbursement trends.
• Meet with department stakeholders to review reporting and assist with root cause analysis.
• Recommend workflow or system changes to improve performance based on analysis.
• Provide the data necessary to drive department accountability and achievement of metrics.
• Promote process standardization across related departments.
• Coordinate with IS on completion of any build or enhancements to the system.
• Identify and ensure necessary training is provided to end users.
• Assist with strategic pricing, chargemaster maintenance, and charge capture reporting.
• Coordinate with report writers to develop department-specific reporting on denials and avoidable write-offs.
• Prepare, compile, and distribute denial and AWO reports.
• Provide trending on the types of claims denied and root causes of denials.
• Maintain an updated issues list on behalf of the HB and PB Denial/AWO Committees.
• Coordinate with IS on completion of any build or enhancements to the system for denial management.
• Maintain contract management system to ensure accurate and current contract terms.
• Perform financial analysis utilizing the contract management system.
• Facilitate contract modeling and reimbursement impact analyses.
• Assess opportunities to maximize reimbursement.
• Perform reviews of $0 balance accounts for appropriate contractual reimbursement.
• Identify, resolve and escalate any major payment discrepancies.
• Provide detailed reporting of payment variance opportunities.
• Develop and maintain payor report card.
• Contact identified payer sources to resolve reimbursement issues.
• Provide frequent updates to leadership on contract performance.
• Perform related duties as assigned.

Benefits

• Actual salary commensurate with experience.
• Remote position, Monday through Friday, 8:00 AM to 5:00 PM, and as needed on occasion.

Knowledge / Skills / Abilities

• High level of customer service skills to establish and enhance positive relationships.
• Excellent ability to understand and interpret statistical reports.
• Advanced skills in problem solving and translation of data into actionable steps.
• Knowledge of insurance claim processing and third party reimbursement.
• Knowledge of managed care fundamentals, including negotiated agreements.
• Knowledge of multiple clinical disciplines and charging practices.
• Knowledge of Information Systems principles.
• Knowledge of state and federal regulations related to billing processes.
• Knowledge of various types of provider reimbursement methodologies.
• Familiarity with both commercial and government payors.
• Advanced analytical skills for contract performance assessment.
• Advanced computer skills for analysis, data management, and reporting.
• Skill in time management and project management.
• Ability to work efficiently under pressure and deal effectively with challenging situations.
• Skill in effective oral, written, and interpersonal communication.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning.
• Ability to deal effectively with constant changes and be a change agent.
• Ability to willingly accept responsibility and/or delegate responsibility.

Working Environment/Equipment

• Standard office environment and equipment.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.