Revenue Integrity Analyst II Remote

University Hospitals Pain Management; Shaker Heights (OH); Remote; USD 65,000 - 85,000; Full time

Job summary

A leading healthcare institution seeks a professional for Charge Description Management. The role involves ensuring compliance with payer operations and governmental regulations while aiding various clinical departments in revenue integrity. Candidates are expected to maintain professional certifications and assist in resolving billing-related issues.

Qualifications

• Professional certification maintenance in good standing is required.

Responsibilities

• Monitor compliance with payer operations and governmental policies.
• Identify and resolve revenue/charge-related issues.
• Assist in charge reconciliation based on clinical documentation.

Job description

DescriptionA Brief Overview

This position is responsible for daily Charge Description Management (CDM), and monitoring, analyzing and ensuring compliance with payer operations.

What You Will Do

• Supports UHHS clinical areas, new/existing service lines and departments (this includes Revenue Cycle Management) as follows:
  • Continually reviews and proactively communicates governmental policy, payer/vendor updates, newsletters and internal Management initiatives to ensure that UHHS services provided to patients are captured and billed in compliance with government regulation, contractual obligation, internal policy/standards or business objectives.
  • Expected to identify, report, and participate in the resolution of any potential or actual revenue/charge related issues.
  • Monitors, and provides additions and updates to the CDM for entry into system master files/tables.
  • Provides additions and updates for system charge routing, edits, and/or errors.
  • Works in conjunction with Sr. Revenue Integrity Analysts, Managed Care/Contracting, and Finance for end of year updates including pricing changes.
  • Works in conjunction Sr. Revenue Integrity Analysts to support annual maintenance and routine analysis of the CDM.
  • Reviews patient records and can assist with account fixes, charge reconciliation for other departments based on clinical documentation.
  • Responds to departmental charging inquiries timely and seeks guidance when appropriate.
  • Works with Coding and other clinical departments to identify/fix errors based on ICD/CPT Coding Guidelines and National Correct Coding Initiative edits.
  • Contributes in the support of quarterly improvement initiatives as directed by department director or manager.
  • Train and assist in daily resolution of billing edits/errors that are holding revenue, by reviewing the medical records and other applicable documentation.
  • Monitors applicable Revenue Integrity KPIs.
  • Assist Revenue Cycle departments with special procedures and various duties as assigned.
  • Success completion of proficiency required to gain access to applicable systems.
• This role requires professional certification maintenance in good standing.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.