Epic Revenue Integrity Analyst

Virtua Health; Mount Laurel Township (NJ); Hybrid; USD 71,000 - 110,000; Full time

Job summary

Virtua Health is seeking a Revenue Integrity Analyst to perform root cause analytics and audits within the Revenue Cycle, supporting an Epic-based EMR across Virtua Hospitals, Physician Groups and Home Health.

The role analyzes data to identify opportunities, validates charge capture, and ensures compliance with government and payer requirements, collaborating with Revenue Integrity, Finance, IT and Clinical Operations for improvements and reporting.

Qualifications

• 3 to 5 years' experience within a large hospital or integrated healthcare delivery system.
• Ability to work collaboratively across disciplines and business lines.
• Exceptional oral/written communication skills and highly customer focused.
• Excellent interpersonal and presentation skills.
• Able to communicate with many, various customers.
• Ability to prioritize, plan and execute.
• Excellent critical thinking, analytical skills.

Responsibilities

• Perform quantitative and financial analysis along with audits to identify opportunities for improvement across the full spectrum of the Revenue Cycle.
• Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payor needs.
• Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
• Works with revenue producing departments to ensure the ongoing coordinated consistency of the charge master and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Conduct analytical reviews determine net revenue effect of proposed charge master and fee schedule changes.
• Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.
• Incumbent must develop close working relationships with management and staff in Revenue Integrity, Finance, Information Technology and Revenue and Clinical Operations allowing them to perform deep-dive analysis and reviews assisting with the identification of trends, solutions and potential corrective action steps.
• Will work both independently and have a high level of self-directed work efforts as well as be an integral part of the Revenue Integrity Team.
• Revenue Cycle will include areas from Hospital, Physician and Home Health.
• Monitor and assists with review of revenue cycle work queues in Epic.
• Perform analysis to identify issues, trending, root cause, and action plan development with work queue issues.
• Assist in strategic pricing process to optimize reimbursement within budget guidelines.
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Assists in troubleshooting and resolving issues related to the patient revenue cycle and assists in development and recommendations.
• Provide guidance and communication and collaborate with Revenue Integrity Team, Clinical Operations and IT to help ensure work queue rules are accurate and updated based on annual and quarterly coding changes.
• Assist with Epic performance reporting, including assisting with Revenue & Usage, Enterprise Charge Reconciliation and Volume Reports.
• Work queue and reporting will include areas from Hospital, Physician and Home Health.
• Serve as resource to Patient Financial Services staff for reporting problems and denials on individual claims.
• Assist in researching coding issues, provide guidance and recommend solution to account representative.
• Analyze billing errors and denial data to identify root cause of issues.
• Work with Revenue Integrity Team, ...

Skills

Cross-functional collaboration

Oral & written communication

Interpersonal skills

Prioritization

Analytical thinking

Education

Bachelor's degree in Accounting, Finance, or Healthcare

Tools

EPIC

Job description

Virtua Health is seeking a Revenue Integrity Analyst to perform root cause analytics and audits within the Revenue Cycle, supporting an Epic-based EMR across Virtua Hospitals, Physician Groups and Home Health.

The role analyzes data to identify opportunities, validates charge capture, and ensures compliance with government and payer requirements, collaborating with Revenue Integrity, Finance, IT and Clinical Operations for improvements and reporting.