Revenue Integrity Analyst II-1

Health Partners Plans; Philadelphia (Philadelphia County); On-site; USD 75,000 - 110,000; Full time

Job summary

Thomas Jefferson University in Philadelphia is seeking a Revenue Integrity Analyst II-1 to improve charge accuracy and integrity across payer regulations. The role collaborates with Revenue Cycle and clinical departments to analyze coding and billing guidelines and to ensure compliant, high-quality charge capture.

The position involves serving as a subject matter expert for revenue cycle issues, identifying charging trends, and advising on optimal charge codes to maximize compliant revenue.

Qualifications

• Bachelor's or Associate's degree in Health Information Management, Business Administration, Accounting, Management, Healthcare Administration.
• RHIA, RHIT, CCS, or CPC credentials required; AAHAM or HFMA preferred.
• Five years experience in a hospital setting or healthcare strongly preferred.
• 1–3 years auditing and/or coding experience required.
• Knowledge of Medicare/Medicaid regulations, including billing, coding and documentation.
• Understanding of IPPS, OPPS and fee schedule.
• Strong oral and written communication skills.
• Excellent organizational and project management skills.

Responsibilities

• Identifies charge edit trends based on documentation, coding or charging issues and recommends workflow opportunities.
• Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• Serves as the service-line liaison between Revenue Cycle and clinical department administration regarding revenue, regulatory, coding, billing and charge capture matters.
• Develops processes to modify existing chargemaster review applications to reduce charge-related claim edits/rejections.
• Advises service-line leaders and staff on proper usage of charge codes; identifies opportunities for capturing additional revenue per payer guidelines.
• Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges.
• Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings.
• Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management.
• Assists in the development and implementation of effective chargemaster review, education and training.

Skills

Communication

Project management

Time management

Mentoring

Education

Bachelor's or Associate's degree in Health Information Management, Business Administration, Accounting, Management, Healthcare Administration

Job description

Number of Positions In Requisition

1

Job Details

Revenue Integrity Analyst II-1

Job Description

PRIMARY FUNCTION :

Works to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices. Responsible for collaborating with Revenue Cycle and clinical departments to ensure accurate and thorough high level analysis of governmental and commercial payer regulations related authorization, coding and billing guidelines. Maintains current knowledge regarding coding guidelines, changing/billing regulations and regulatory agency activities.

ESSENTIAL FUNCTIONS:

Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Primary clinical service-line liaison regarding payor guidelines, explaining regulatory requirements, and ensuring accountability and solid charge workflows for revenue integrity.

Serves as the subject matter expert for clinical departments on issues related to revenue cycle.

• - Identifies charge edit trends based on documentation, coding or charging issues and recommends workflow opportunities.
• - Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• - Serves as the service-line liaison between Revenue Cycle and clinical department administration regarding revenue, regulatory, coding, billing and charge capture matters.
• - Develops processes to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• - Advises service-line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines.
• - Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges.
• - Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings.
• - Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management.
• - Assists in the development and implementation of effective chargemaster review, education and training.

EDUCATIONAL/TRAINING REQUIREMENTS:

• - Bachelor's or Associate's degree in Health Information Management, Business Administration, Accounting, Management, Healthcare Administration.

CERTIFICATES, LICENSES, AND REGISTRATION :

• - Must hold and maintain one or more of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
• - Applicable professional certifications from American Association of Healthcare Administrative Management (AAHAM) or Healthcare Financial Management Association (HFMA) preferred.

EXPERIENCE REQUIREMENTS:

• - Five years experience in a hospital setting or within the healthcare industry strongly preferred.
• - 1 - 3 years of experience related to auditing and/or coding is required.
• - Knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.
• - Understanding of various reimbursement systems including IPPS, OPPS and fee schedule.
• - Strong oral and written communication skills.
• - Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations.
• - Ability to document clinical workflows impacting revenue cycle.
• - Strong written communication, presentation skills, and excellent customer service skills.
• - Excellent organizational and project management skills.
• - Strong time management, attention to detail, and follow through.
• - Motivated individual who can mentor and inspire in a team environment.

Work Shift Workday Day (United States of America)

Worker Sub Type Regular

Employee Entity Thomas Jefferson University Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and