Revenue Integrity Analyst

Beth Israel Lahey Health; United States; On-site; USD 3,499,000 - 4,959,000; Full time

Job summary

Beth Israel Lahey Health seeks a Revenue Integrity Analyst to support professional and hospital billing, educate providers, and optimize revenue capture across modalities. You will work with Service Line Directors, Finance, and Epic system teams to ensure compliant, accurate charge capture and timely system updates.

This role requires knowledge of CMS rules, CPT/HCPCS, ICD-10, and proficiency with Epic. You’ll monitor revenue reports, develop dashboards, and participate in audits and initiatives

Qualifications

• Comprehensive working knowledge of medical/hospital billing practices, CMS regulations.
• Knowledge of CPT, HCPCS, and ICD-10 coding principles.
• Knowledge of Epic or related hospital ADT/Billing software.
• Proficient in data entry and use of Excel.
• Ability to read and interpret financial reports.
• Problem solving with analytical thinking and attention to detail.

Responsibilities

• Provide high-level revenue cycle support for professional and hospital billing.
• Analyze charge capture workflows and suggest improvements for accuracy and efficiency.
• Draft internal controls to comply with payer policies and contract changes.
• Monitor revenue and reports and recommend front-end workflow improvements.
• Collaborate with Epic analysts on revenue cycle modules and upgrades.
• Develop dashboards and reporting for KPIs and productivity.
• Stay current on coding, billing rules, and Epic system changes.
• Participate in audits and complex revenue projects as needed.

Skills

Medical billing

CMS regulations

CPT/HCPCS/ICD-10

Epic knowledge

Data entry

Financial reports

Problem solving

Attention to detail

Organization

Multitasking

Excel skills

Education

Associates Degree

Tools

Epic system

Job description

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Under the managerial oversight of the Director the Revenue Integrity Analyst serves as a primary point of contact for Service Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, hospital colleagues and others regarding matters that relate to aspects of professional and hospital revenue charge capture and other matters relating to professional and hospital revenue cycle and modality specific billing processes and/or workflows. The Revenue Integrity Analyst is responsible for educating providers, clinical colleagues and other members of their assigned modality specific revenue cycle teams regarding accurate professional and facility billing and revenue capture while adhering to CMS and third party payer regulations. The Revenue Integrity Analyst is responsible for assisting in the implementation of new revenue capture procedure records within the hospital chargemaster (CDM) and the development of workflows to ensure timely and accurate capture of all Lahey Health System revenue. The Revenue Integrity Analyst seeks to improve workflow, efficiency, accuracy, reimbursement and overall revenue cycle billing through operational and system enhancements and/or modifications. The Revenue Integrity Analyst is responsible to ensure that Lahey Health is maximizing accurate gross revenue capture to ensure maximum net revenue reimbursement is attained, sustained, and supported.

Job Description: Essential Duties & Responsibilities including but not limited to:

1. 1. Responsible to provide a high level of all-around Revenue Cycle support for professional service on and off site locations staff, hospital facilities clinical staff, PFS professional and hospital billing staff, Epic system analyst colleagues, Finance leadership, and Revenue Cycle Leadership.
2. 2. Required to be available for Ad hoc PFS representation at interdepartmental, finance, and/or various onsite/offsite department revenue cycle meetings to assist with the evaluation of charge capture workflows and make recommendations to improve the accuracy and efficiency in capturing professional and facility revenue.
3. 3. Responsible to analyze, communicate, and draft internal controls and operational changes to comply with complex changes to government and third party payer policies, regulations and contract changes.
4. 4. Responsible to monitor and analyze various monthly/weekly/daily revenue and late charge reports. Responsible to monitor and analyze daily/weekly/monthly WQ data including Revenue Guardian holds, Charge Review, Router Review, and Claim Edits in order to make recommendations to correct any negative trends, high volume failures, and to improve front end work flow and procedures for both professional and clinical areas.
5. 5. Responsible to work closely with Epic system analysts within all charge capture modules in the upgrading, testing and implementation of any and all revenue cycle software products that impacts revenue capture, claim scrubbing, while ensuring Lahey Health adheres to compliance regulations set forth for both professional and hospital billing.
6. 6. Responsible for the monthly production and maintenance of reporting mechanisms detailing departmental productivity and assist in the development, implementation, training and education, maintenance, and reporting of revenue capture initiatives.
7. 7. Responsible to remain current on new services being performed throughout the Healthcare System in order to maximize revenue capture. Has full knowledge of chargemaster maintenance policies and procedures in order to perform internal audits.
8. 8. Responsible to actively participates in the development and maintenance of revenue capture in electronic systems and any documents including downtime encounter forms (i.e,charge tickets). The Revenue Integrity Analyst assists in coordinating and maintaining accurate revenue capture preference lists containing charge code record selections with members of the modality specific professional and/or clinical staff.
9. 9. Responsible for keeping abreast of all government and payor level coding, billing, reimbursement rules, regulations, and guidelines related to professional and hospital revenue capture and billing. Responsible updating Epic system and informing SLD, Dept Managers, and other leadership of significant changes in a timely manner.
10. 10. Responsible to participate in complex projects and or audit related to revenue initiatives and complex investigations into allegations of fraudulent billing or abuse, as necessary. Provides support for projects in which Senior Leadership is involved.
11. 11. Responsible to develop, trend, and report monthly and annual statistical reporting dashboard data to coincide with departmental and organizational KPIs (Key Performance Indicator).
12. 12. Responsible to proactively identifies problems or opportunities for improvements related to clinical orders,clinical documentation, and preference lists that are or should be linked to professional and/or hospital charge records. Makes recommendations to management and/or the perspective departments where high volume/high dollar values have been determined and creates Epic remedy tickets for improvements/changes to take place.

Minimum Qualifications:

Education: Associates Degree. In the absence of an Associate’s Degree preferably in the business or finance field, an additional 4 years of healthcare revenue cycle experience above the five identified below are required.

Licensure, Certification & Registration: Epic proficiency or certification in Charge Description Master

Experience: Requires minimum 2 years of healthcare revenue cycle experience.

Skills, Knowledge & Abilities:

• Comprehensive working knowledge of medical/hospital billing practices, billing software, health care insurance, and CMS regulations
• Knowledge of CPT, HCPCS, and ICD-10 coding principles.
• Knowledge of Epic or related hospital ADT/Billing software.
• Thoroughly proficient in data entry using a pc and a variety of electronic systems.
• Ability to read, analyze and interpret financial reports.
• Ability to define problems, collect data, establish facts and draw conclusions, and make sound recommendations.
• Capacity to analyze and think creatively and weigh alternatives.
• Perception of people and an awareness to deal with conflict successfully and attain resolution
• Demonstrates attention to detail.
• Demonstrates excellent organizational skills.
• Demonstrates skills with multitasking
• Demonstrates proficiency in the use of excel documents

Pay Range: $25.40 - $36.00 The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

Equal Opportunity Employer/Veterans/Disabled At Beth Israel Lahey Health, we are driving the change in health care that Massachusetts wants and needs.

Our culture promotes continuous learning, growth, innovation and a sense of belonging. We make it a priority to offer comprehensive compensation and benefits and help you achieve a healthy and balanced life. While you're busy caring for and supporting our patients, we take care of you.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.