Revenue Integrity Coordinator

St. Joseph's Health; City of Syracuse (NY); On-site; USD 75,000 - 95,000; Full time

Job summary

St. Joseph's Health in Syracuse, NY is seeking a Revenue Integrity Analyst to perform in-depth analysis of clinical and billing data, identify documentation and denial issues, and develop action plans to prevent denials while supporting compliance.

This role involves collaborating with clinical and PBS teams, conducting audits, educating staff, and tracking metrics. Occasional travel within the region may be required as part of denial prevention and process improvements.

Qualifications

• Bachelor’s degree in healthcare or business-related field required.
• Five+ years in billing, charge documentation, audits or related revenue cycle work.
• Proficiency with MS Excel; Access, Business Objects, Word and PowerPoint desired.
• Knowledge of third-party payer rules and regulatory billing updates.

Responsibilities

• Perform in-depth analysis of patient clinical and billing data to identify documentation and denial issues.
• Develop and implement action plans for denial prevention based on root cause analysis.
• Collaborate across departments on denial coordination and compliance.
• Conduct departmental audits and report findings with recommendations.
• Travel up to 25% between locations within the Region.

Skills

Billing & denial management

Data analysis

Process improvement

Regulatory knowledge

Education

Bachelor's degree in Healthcare or related field

Professional coding certification (RHIA/RHIT/CCS/CPC/COC)

CDC Healthcare Compliance Certification preferred

Tools

MS Excel

Access

Business Objects

Word

PowerPoint

Job description

Employment Type:

Full time

Description:

50% role will be operations and 50% will support front end eligibility and denials

POSITION PURPOSE

Responsible for performing in-depth analysis of patient clinical and billing data to identify documentation, coding and denial prevention. Develops and implements action plans for denial prevention based on root cause analysis findings. Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines. Responsible for working complex denial coordination with intra-team members to identify root cause. Performs audits and collaborates with intra and inter-departmental teams on compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. Completes assigned reports timely and accurately. May be required to travel between locations within the Region.

As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Collaborates with intra-departmental team on denial investigations and root cause analysis, which includes identifying opportunities for denial prevention along the revenue cycle. Performs analysis of data and reporting of trends, performance metrics, process improvements and impact to revenue.

Performs other revenue optimization activities as appropriate, which includes providing education, process improvement, ongoing assessment and resolution of root cause issues. May assist centralized charge control team when necessary.

Conducts departmental audits to ensure proper documentation and compliance with state and federal guidelines relating to the charge capture and billing of services. Prepares and submits audit findings, makes recommendations, and works closely with revenue integrity leadership and inter-departmental leaders to implement solutions.

Collaborates with clinical departments, Patient Business Service (PBS) center, Payer Strategies, Compliance and other revenue cycle departments on denial coordination, denial prevention and pre-bill edit prevention.

Works closely with Revenue Liaison and/or Physician operational leaders, on system implementations, enhancements and new service line requests to ensure revenue cycle integrity and compliance.

Works with ancillary teams and providers to develop processes to prevent future denials.

Works in conjunction with leadership to track potential risk accounts and reviews with Finance to ensure there are no impacts to current reserves in the Bad Debt Charity Operational write-offs (BCO) model.

Attends meetings with payer representative and/or vendors to address outstanding issues and/or stay informed of new regulations or guidelines. Attends monthly denial management meetings at individual ministries.

Coordinates denials and appeals and/or reconsideration requests on clinical, coding and technical denials with PBS center, which may include outpatient RAC denials and appeals. Maintains denial and/or appeals logs and assessments in accordance with associated guidelines.

Maintains an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.

Maintains working knowledge of coding and billing regulations for all payors. Keeps current on regulatory updates, local payer policies and procedures to ensure charge accuracy, compliance and optimization.

Other duties as assigned.

Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior

QUALIFICATIONS

Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field, or an equivalent combination of years of education and experience.

Five (5) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.

Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.

Working knowledge of third party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.

Must possess a demonstrated knowledge of clinical processes; charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing.

Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).

Must be able to work in an environment that may be stressful with a variety of individuals having diverse personalities and work styles.

Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.

Experience with post payment audits and with coding, clinical and technical denials is required.

Excellent interpersonal, verbal and written communication and organizational abilities. Accuracy, strong analytical skills, attentiveness to detail and time management skills are required.

Must be comfortable operating in a collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

1. This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards.

2.Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.

3.Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.

4.The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions.

5.Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.

6.Ability to thrive in a fast-paced, multi-customer environment, with conflicting needs which some may find stressful. May warrant varied and/or extended hours, with changes in workload and priorities to keep pace with the industry and advance strategic priorities.

7.Must possess the ability to comply with Trinity Health policies and procedures.

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8.May be required to travel up to 25% between locations within the Region.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Additional

Additional

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.