CASY-MSCCN Jobs

• Job Type: Officer of Administration
• Bargaining Unit:
• Regular/Temporary: Regular
• End Date if Temporary:
• Hours Per Week: 35
• Standard Work Schedule:
• Building:
• Salary Range: 65,000-85,000

Position Summary

Reporting to the Director Revenue Cycle, the Revenue Integrity Analyst provides revenue cycle support to the Department of Emergency Medicine.

The Revenue Integrity Analyst is responsible for the clinical appeal of claims denied for medical necessity, clinical reimbursement policies such as bundling, and other denials as needed. This Analyst will perform monthly quality reviews of coding to ensure accuracy and compliance with all CMS and AMA CPT guidelines. This Analyst will compile reports and analysis on department denial trends and help prioritize issues for escalation. This Analyst will work collaboratively with the coding vendor, clinical leadership, the Clinical Revenue Office, and Office for Billing Compliance to optimize clinical documentation workflow and templates in to improve documentation quality and reduce administrative burden on department providers.

Opportunity for hybrid schedule.

Responsibilities

• Performs monthly quality reviews of coded claims. Compiles reports on quality reviews to share feedback with coding vendor and department leadership. Escalates issues identified and suggests remediation when appropriate.
• Reviews documentation and submits clinical appeals and charge corrections for denied claims.
• Works collaboratively with clinical leadership to design templates for clinical appeals.
• Works collaboratively with FPO and IT to optimize clinical denials workflow.
• Compiles monthly denial reports and analyzes trends. Escalates issues to Revenue Cycle Director. Suggests prevention strategies and workflows. Helps prioritize provider education opportunities.
• Leads moderately complex clinical denial projects and payer escalations, including root cause analysis, payer policy research, workgroup meeting participation, workflow design.
• Works collaboratively with clinical leadership, IT, Clinical Revenue Office, and Office of Billing Compliance to optimize documentation templates and workflow.
• Acts as a subject matter expert on coding and charge capture. Reviews, monitors, and facilitates implementation of billing and coding changes affecting charge capture processes in accordance with payer requirements.
• Maintains a thorough working knowledge of all aspects of billing and collections including billing rules and regulations, collection practices, electronic billing processes, CMS 1500 Form requirements, diagnosis and CPT/HCPCS coding, and applicable county, state, and federal requirements.
• Cross covers other duties as needed.
• Must successfully complete systems training requirements.
• Must maintain certification throughout employment.

Minimum Qualifications

• Bachelor's degree or equivalent in experience with at least three years of relevant healthcare experience.
• Current Coding Certificate is required (ex: CPC, CCS, CCSP).
• Must have in-depth knowledge of Medicare/Medicaid regulation.
• Must have ability to critically analyze and reason data.
• Must demonstrate strong verbal and written communication skills; have ability to exercise excellent judgment and diplomacy in all interactions.
• Must possess excellent organizational skills, use sound judgment in prioritizing work, and possess a professional sense of accountability.
• Must demonstrate proven ability to interact with all levels of faculty and staff.

Preferred Qualifications

• Prior experience coding emergency medicine professional services strongly preferred.
• Working knowledge of electronic medical records and billing systems including EPIC
• Experience in large academic medical center or similarly complex health system.

Other Requirements

• Must successfully complete systems training requirements.
• Must stay abreast with medical terminology, as well as a knowledge of current codes and coding regulations.
• Must maintain certification throughout employment.