RN Revenue Integrity Analyst

Mercy Health Corporation; Janesville (WI); On-site; USD 75,000 - 112,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

Paid time off

Job summary

Mercy Health Corporation seeks an experienced Revenue Integrity professional to partner with clinical leaders and ensure accurate charge capture, coding, and billing practices across service lines. The role includes evaluating charging processes, guiding staff on CPT/HCPCS usage, and monitoring EPIC dashboards in a day shift, 40 hours per week.

The candidate should have RN licensure, a BSN, 3+ years in revenue cycle, and experience with hospital coding/revenue integrity projects.

Qualifications

• Bachelor of Science in Nursing degree and +three (3) years of experience within the revenue cycle.
• Experience above minimum requirement will be considered in lieu of education.
• Experience: In excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; hospital leadership.
• Knowledge of CPT/HCPCS procedural coding preferred.

Responsibilities

• Interacts with clinical department directors to monitor charge capture functions across all entities.
• Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
• 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.
• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities.
• Monitors EPIC Revenue Integrity Dashboard(s)
• Participates in moderately complex projects related to revenue integrity initiatives.
• Provide support for assigned cost centers within service lines
• Participates in analyzing changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Train and assist clinical team with revenue integrity functions.
• Performs miscellaneous duties as assigned.

Skills

Analytical skills

Communication skills

Revenue cycle knowledge

Project management

Education

BSN in Nursing

Tools

EPIC HB/PB

CPT/HCPCS coding

Job description

OVERVIEW

Seeking an experienced Revenue Integrity professional to partner with clinical leaders and ensure accurate charge capture, coding, and billing practices across service lines. This role evaluates charging processes, identifies revenue opportunities, monitors EPIC Revenue Integrity dashboards, supports compliance with payer and regulatory requirements, and provides education and guidance to clinical teams. The ideal candidate has strong analytical and communication skills, healthcare revenue cycle knowledge, and the ability to manage moderately complex revenue integrity projects.

Schedule: 40 hours per week

Shift: Day Shift Hours

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Interacts with clinical department directors to monitor charge capture functions across all entities.
• Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
• 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.
• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities.
• Monitors EPIC Revenue Integrity Dashboard(s)
• Participates in moderately complex projects related to revenue integrity initiatives.
• Provide support for assigned cost centers within service lines
• Participates in analyzing changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Train and assist clinical team with revenue integrity functions.
• Performs miscellaneous duties as assigned.

GENERAL EXPECTATIONS

• Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
• Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders.
• Excellent organizational and project management skills.
• Strong time management, attention to detail, and follow through.
• Well-developed research skills.
• Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
• Work effectively as a team contributor on all assignments.
• Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
• Delivers positive patient experience, where applicable.

EDUCATION & EXPERIENCE

• Bachelor of Science in Nursing degree and +three (3) years of experience within the revenue cycle.
• Experience above minimum requirement will be considered in lieu of education.
• Experience: In excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; hospital leadership.
• Clinical leadership experience preferred with high level focus charges/revenue. EPIC HB/PB experience preferred. Knowledge of CPT/HCPCS procedural coding preferred.

CERTIFICATION/LICENSURE

• Licensed as an RN in state of practice
• Approved CPR or BLS certification required within 90 days (Other certification per unit requirements: ACLS, PALS, PEARS, NRP)

SPECIAL PHYSICAL DEMANDS

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to sit; climb or balance and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this position include close vision, distance vision, peripheral vision, and depth perception.

LEVEL OF SUPERVISION

Responsibilities include training employees; planning, assigning, and directing work; self-directed project management, addressing complaints and resolving problems; self-adherence to annual education and certification requirements

PAY RANGE:

$74,569.65 - $111,854.48

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Certification Reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

At Mercyhealth, we don't simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our commitment to our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50
• One of Working Mother magazine's 100 Best Companies for Working Mothers
• A Top 50 Company and Top 10 Nonprofit for Executive Women