Revenue Integrity Analyst III

Description

JOB SUMMARY

Responsible for researching, managing, coordinating, and implementing Charge Description Master (“CDM”) and charge capture initiatives and processes to ensure revenue management and revenue protection. Ensures the overall integrity of the CDM. Conducts audit/review activities to ensure appropriate revenue management, claims production, and coding integrity. Research and maintains compliance with state, federal, and other third-party payor billing and reimbursement guidelines. Conducts special projects and studies to facilitate revenue management as required. Works independently; performs duties requiring the exercise of discretion and independent judgment; has ability to make decisions after comparing and evaluating possible courses of action; formulates, affects, interprets, or implements management policies or operating practices; prioritizes and manages multiple tasks to meet deadlines; seeks guidance from manager as needed to clarify assignments or requests, ask questions, or seek additional information.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes, including price analysis.
• Serves as a subject matter expert and in a consultative role to various levels of customers including patient accounting systems; works closely and collaboratively with other internal departments.
• Reviews CDM change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges; imparts knowledge to facilities regarding requested changes
• Provides guidance and education related to billing and charge capture of services to multiple staff levels; facilitates proper recording of transactions in compliance with state, federal, and other third-party payor guidelines.
• Conducts special projects and special studies to facilitate revenue management as required for system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, etc.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Advanced knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement.
• Advanced knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance.
• Advanced knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines.
• Ability to recognize, research and correct charging/documentation discrepancies.
• Advanced knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues.
• Advanced knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
• Ability to establish and maintain effective working relationships as required by the duties of the position.
• Strong interpersonal communication and presentation skills, effectively presenting information to management, facility groups, and individuals.
• Advanced knowledge of CPT/HCPCS codes, revenue codes.
• Comprehensive knowledge of CMS laws, rules, and regulations governing CDM/CPT/Edits.
• Ability to respond to complex inquiries in a professional manner.
• Strong understanding of Revenue Integrity/Charge Description Master, its impact throughout the revenue cycle, and contribution to revenue management.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Experience Required: 5+ years of healthcare-related experience.
• High School graduate or equivalent required.
• College degree preferred.
• Prior CDM or charge capture experience required.
• Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, COC, CPC, CCS highly desirable

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel*
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments*

_{*May require these demands}

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment
• Hospital Work Environment

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $64,168.00 - $96,262.00 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.