Revenue Integrity Analyst

Talentify; Rapid City (SD); On-site; USD 34,000 - 42,000; Full time

Benefits offered by this job

Medical, Vision and Dental Coverage

Retirement Plans

Flexible Spending Account

Instant pay

Job summary

The Revenue Integrity Analyst at Monument Health Rapid City Hospital, Inc. is responsible for monitoring charge capture, coding accuracy, and variances between billed amounts and expected reimbursement from payers.

This role requires knowledge of state and federal regulations and payer contracts to defend claims submissions for services provided. You will perform prospective and retrospective audits, verify EMR data and charges, and collaborate with the Revenue Cycle team to improve charge

Qualifications

• Experience in healthcare billing, payment processing and denial management.
• Knowledge of state and federal laws and payer contracts relevant to revenue integrity.
• Auditing and monitoring charge capture and coding accuracy.

Responsibilities

• Understands the Revenue Cycle and department goals and their impact on financial health.
• Performs audits to detect omissions or errors in charge capture, coding, and billing.
• Verifies EMR data, charges, and denial reasons; communicates corrections.
• Supports denial management and appeals processes with payors and care teams.
• Maintains documentation and reporting on audits and improvements.

Skills

Charge capture

Revenue Cycle software

Denials management

Audit techniques

Regulatory compliance

Education

High School Diploma/ GED

Bachelor's degree in healthcare management

Tools

EMR systems

Revenue Cycle software

Job description

Primary Location

Rapid City, SD USA

Department

RCH Revenue Cycle Integrity and Innovation

Scheduled Weekly Hours

40

Starting Pay Rate Range

$24.43 - $30.54

(Determined by the knowledge, skills, and experience of the applicant.)

Job Summary

The Revenue Integrity Analyst is accountable for monitoring charge capture, coding and variances between actual and expected reimbursement from payers. Accurately compiles information required to defend claims submission for specific services provided. Knowledge of state and federal laws and industry standards that relate to contracts, charge capture and to the appeal process is vital.

Benefits

• Supportive work culture
• Medical, Vision and Dental Coverage
• Retirement Plans, Health Savings Account, and Flexible Spending Account
• Instant pay is available for qualifying positions
• Paid Time Off Accrual Bank
• Opportunities for growth and advancement
• Tuition assistance/reimbursement
• Excellent pay differentials on qualifying positions
• Flexible scheduling

Job Description

Essential Functions:

• Understands the Revenue Cycle and the responsibility and goals of each area and how they impact the financial wellbeing of the organization.
• Demonstrates knowledge of compliance standards and payor specific data to properly file claims, ensuring prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients.
• Demonstrates working knowledge of interfaced, integrated Revenue Cycle software support tools.
• Verifies all necessary elements in the electronic medical record; appropriate charges for services rendered, accurate coding for services, reason for denials, denial status, and appeal and results of action taken.
• Performs prospective and retrospective audits, using appropriate tools to detect omissions or errors in charge capture, coding and billing.
• Verifies accuracy of transactions which appear on the account and communicates errors, omissions and corrections to appropriate caregivers.
• Understands the basics of outpatient Health Information coding, with emphasis on assigned specialties/departments.
• Has a working knowledge of the procedures and EHR workflows that are in place to generate charge capture, for assigned departments.
• Identifies additional or corrected information needed to process a denied claim through communications with the Revenue Cycle team or payor representatives in a timely manner, to expedite payor reimbursement.
• Works with Revenue Integrity leaders and caregivers to assure accurate and complete Charge Description Masters and Physician Fee Schedules via scheduled review.
• Provides a detailed and complete report monthly of charge capture audits, denials, appeals, follow-up and results on appealed accounts, root cause analysis of issues responsible for inaccurate charge capture or denied services.
• Participates in the planning, development, implementation, and maintenance of departmental monitoring tools
• Additional duties as assigned..

Additional Requirements

Required:

Education - High School Diploma/ GED

Experience - Healthcare Billing, Payment Processing, and Denial Management 3+ years
Preferred:

Education - Bachelors degree in healthcare management

Certification - Revenue Integrity certification through the appropriate agency within two years of employment

Physical Requirements

Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Revenue Cycle

Job Family

Revenue Integrity

Shift

Requires the ability to work assigned schedules and hours as determined by the department

Employee Type

Regular

10 Monument Health Rapid City Hospital, Inc.

Make a difference

Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.