Charge Capture and Reconciliation Analyst

100 Albany Med Health System; Broadway (NC); On-site; USD 64,972 - 97,458; Full time

Job summary

Albany Medical Center seeks a Revenue Integrity Analyst to support hospital and physician charge capture and revenue improvement initiatives. The role collaborates with coding, billing, clinical teams to ensure accurate charging and supports compliance efforts.

The position manages revenue cycle reporting, data analysis, auditing, and policy implementation, partnering with leadership to promote new processes and reduce billing delays.

Qualifications

• Associate's Degree in HIM, healthcare finance, or related discipline is required.
• Three years of hospital clinical and financial data experience with complex relationships to solve charge capture issues.

Responsibilities

• Identify compliance risk through RAC Audit requests and reporting.
• Collaborate with billing and stakeholders to resolve issues and accelerate revenue.
• Monitor revenue cycle dashboards and generate KPI-related information.
• Develop reports to support Service Level Agreements and prompt issue resolution.

Skills

Excellent verbal and written沟通 skills

Strong independent worker

Ability to manage multiple priorities

Education

Associate's Degree in HIM, healthcare finance, or related discipline

Tools

Epic

Microsoft Excel

Microsoft PowerPoint

Microsoft Word

Microsoft Access

Job description

Department/Unit: AMHS Revenue Integrity

Shift: Day (United States of America)

Salary Range: $64,972.00 - $97,458.00

Under the direction of the Revenue Integrity Manager, this position is responsible for supporting hospital and physician charge capture and revenue improvement initiatives. The role collaborates with coding, billing, clinical, and charge champions to ensure accuracy in charging, develops and implements charge capture policies, and supports compliance efforts. It also manages revenue cycle reporting, data analysis, database development, information systems implementation, and auditing.

Responsibilities

• Identify compliance risk through timely review of RAC Audit requests, ensuring timely appeals, and reporting risks to Legal Services and Corporate Compliance Departments.
• Take immediate action on issues identified by Legal Services or Corporate Compliance.
• Build and nurture collaborative relationships with the AMI-IS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system to promote new processes.
• Collaborate with billing and internal stakeholders to resolve issues, decrease billing delays, and accelerate revenue.
• Monitor revenue cycle dashboards and other production reports that generate information related to key performance indicators.
• Identify deficiencies in processes, impactful trends, and missed opportunities to collect revenue.
• Demonstrate knowledge of hospital systems and serve as a resource to department staff.
• Advise departmental staff and charge champions on proper usage of charge codes based upon medical record analysis.
• Work with hospital departments to implement internal controls when errors are identified.
• Establish processes to collect, review, and analyze revenue cycle metrics data, present trends to fiscal leadership, and maintain the monthly revenue cycle dashboard.
• Organize workflow, problem-solve, and manage multiple ongoing priorities with minimal supervision.
• Effectively communicate with AMHS leadership, management, and staff.
• Maintain positive interaction with department staff regarding data entry status, completeness, or other information concerns.
• Develop reports to support Service Level Agreements, ensuring prompt response to issues/concerns leading to improper billing coding and charging.
• Create processes to perform and/or support underpayment analysis and work with Patient Accounting to resolve payment variance.
• Identify and report opportunities to improve processes, procedures, systems, and organizational structures.
• Serve as a liaison with vendors when information relating to data, analysis, and payer processes is involved.
• Keep current with industry knowledge, including healthcare payers and changing requirements, and attend training sessions as needed.
• Act as a source of reference for enterprise on regulatory, reimbursement, or billing changes, developing and implementing training to maintain compliance with federal and state regulations.
• Maintain a working knowledge of revenue cycle processes to aid in implementing regulatory standards that assist compliant charge capture practices.
• Monitor compliance with corporate, federal, and state guidelines, including reviewing commercial bulletins for HCPCS/CPT code changes and billing unit rule changes.
• Perform other duties as assigned.

Qualifications

• Associate's Degree in HIM, healthcare finance, or related discipline - required.
• Three years of experience in hospital clinical and financial data, and expertise working with complex relationships to produce solutions that ensure appropriate charge capture - required.
• Epic experience - preferred.
• Strong theoretical and practical working knowledge of how a healthcare Revenue Cycle ecosystem should work (best practice).
• Advanced skills using Microsoft Excel, PowerPoint, Word, and Access.
• Strong independent worker with known ability to prioritize and prioritize tasks as required.
• Demonstrated ability to manage multiple priorities and meet all established deadlines.
• Excellent verbal and written communication skills.
• Knowledge and expertise across all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing, collection processes, and payer regulations.
• Demonstrated ability to identify data and analytic challenges, including data integrity, appropriateness of data sample, and consistency between sources.
• Experience fully leveraging analytic tools to develop trends and establish dashboards.
• Knowledge of CMS local, state, and federal regulatory requirements and the various data elements associated with all types of claim forms.
• Certified Revenue Cycle Representative (CRCR), CPC, CCS, or other coding credential - preferred.
• Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing – Occasionally
• Walking – Occasionally
• Sitting – Occasionally
• Lifting – Constantly
• Carrying – Rarely
• Pushing – Rarely
• Pulling – Rarely
• Climbing – Rarely
• Balancing – Rarely
• Stooping – Rarely
• Kneeling – Rarely
• Crouching – Rarely
• Crawling – Rarely
• Reaching – Rarely
• Handling – Occasionally
• Feeling – Occasionally
• Talking – Constantly
• Hearing – Constantly
• Repetitive Motions – Frequently (Eye/Hand/Foot Coordination)
• Working Conditions – Extreme cold – Rarely; Extreme heat – Rarely; Humidity – Rarely; Wet – Rarely; Noise – Occasionally; Hazards – Rarely; Temperature Change – Rarely; Atmospheric Conditions – Rarely; Vibration – Rarely

Albany Medical Center is an equal opportunity employer. This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.