Sr. Revenue Integrity Liaison

Piedmont Healthcare Inc.; Atlanta (GA); Remote; USD 90,000 - 130,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a Revenue Integrity Analyst to support Diagnostic Radiology and related service lines. The role focuses on charge capture integrity, billing compliance, and collaboration with clinical departments to improve revenue outcomes.

Responsibilities include auditing, education on correct processes, and developing plans to optimize reimbursement while ensuring adherence to CPT/HCPCS rules and government regulations.

Qualifications

• Advanced CPT/HCPCS coding knowledge.
• Excellent interpersonal and communication skills.
• Strong Windows-based software proficiency (Excel/Outlook/Access).
• Epic, MedAssets, 3M experience desirable.

Responsibilities

• Evaluate current charging and coding structures for revenue capture and compliance.
• Guide charge capture, coding and billing processes across complex departments.
• Develop plans to increase revenue integrity and prevent losses.
• Analyze business and clinical processes to optimize reimbursement and compliance.
• Serve as primary revenue cycle liaison for the most complex departments.
• Perform data collection/analysis to support strategic revenue initiatives.
• Produce executive summaries and KPI reports for performance improvement.

Skills

Advanced CPT/HCPCS coding

Interpersonal communication

Presentation skills

Project management

Education

Bachelor’s Degree in Healthcare or related field

Tools

Epic

MedAssets

3M

CDM maintenance

Excel

Outlook

Access

Windows

Job description

Overview

Experience the advantages of real career change

Join Piedmont to move your career in the right direction. Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You’ll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.

Responsibilities

Remote

Primarily responsible for providing charge management support for Diagnostic Radiology, along with assisting with Interventional Radiology, Invasive Neurovascular, Nuclear Medicine, and Cardiology service lines.

Plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions, and interdependencies from the provision of patient care to final bill generation. With responsibility for the most complex clinical departments and practices and acting with a high degree of autonomy, performs various audits with a focus on revenue cycle integrity. Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills, as well as well-developed analytic and organizational skills. Provides oversight to junior analysts to ensure deadlines are met and projects are completed. This position is responsible for providing assistance in maintaining systems, processes, and workflows for the timely and accurate recording of hospital revenue regarding charge capture. Serves as a facility liaison to PHC hospital staff as it relates to charge capture/billing concerns and works with the operational and clinical departments to ensure optimal charge capture processes are established and maintained. Using knowledge of state and federal guidelines, this position monitors compliance and ensures timely entry of patient charges. This position maximizes charge efficiency through:(1) Monitoring revenue cycle processes and staff functions, (2) Supporting PHC's revenue capture and integrity through evaluating the accuracy of charge capture and billing functions and staying apprised of payer and/or regulatory updates, (3) Assisting in the design and implementation of charge capture/billing workflow improvements.

Qualifications

Education

• Bachelor’s Degree from a recognized college or university Required or
• In Lieu of degree six (6) years of relevant work experience will be accepted in addition to the experiencerequirement. Required

Work Experience

• 5 years healthcare experience in an acute care hospital setting Required or
• In lieu of degree 11 years healthcare experience in an acute care hospital setting Required
• Hospital outpatient coding experience Preferred
• Experience in hospital charging/billing or performance charge review Preferred
• RN and/or clinical operations experience Preferred
• Experience working with EPIC Preferred

Licenses and Certifications

• Certified Coder-AHIMA or AAPC AHIMA certification (e.g. RHIA, CCS, RHIT); AAPC certification (e.g. CPC, CPH, CA) Upon Hire Required or
• applicable clinical or professional certifications/licenses such as RN, RT, MT, RPH, ARRT Upon Hire Required
• Dual Hospital and Professional Coding Certification(s) (e.g., CPC, CPC-H, CCS, CCSP) Preferred

ADDITIONAL QUALIFICATIONS

Hospital outpatient coding experience preferred. Experience in hospital charging/billing or performance charge review preferred. Expert knowledge of CPT/HCPCS coding rules, Charge Master build/maintenance, Clinical charging practices, and billing regulations and practices. RN and/or clinical operations experience a plus. Experience working with EPIC.

KEY RESPONSIBILITIES

1. 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 payor requirements.

2. Provides guidance, communication and education on correct charge capture, coding and billing processes to multiple clinical departments and practices.

3. Assist with developing departmental program planning, strategy and goals for increased revenue integrity.

4. Analyzes business processes, clinical processes, coding processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future losses and to optimize reimbursement based on compliance standards.

5. Acts as primary revenue cycle liaison for the most complex clinical departments.

6. Perform data collection, tracking and analytical duties to respond to key issues, increase revenue integrity and process efficiency in support of the strategic initiatives and goals.

7. Responsible for ongoing development and reporting of executive summaries and detailed key performance improvement indicators with the development of performance metrics as a part of the plan.

8. Work collaboratively with clinicians, auditors, revenue cycle teams to understand services provided to explore and capitalize on opportunities for enhanced revenue integrity (minimize charge leakage, maximize compliance reimbursement).

9. Prepare departmental summaries that pinpoint root causes of charging/billing errors and conceptualize process changes for service line leaders, uses hospital denial data to support findings.

10. Collaborate with revenue assurance leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement.

11. Oversees and evaluates orientation and training of assigned associates. May provide input in the review and evaluation of staff performance.

12. Performs complete revenue cycle reviews, including Charge Description Master (CDM) and related audits with a focus on revenue cycle integrity.

13. Ability to reduce manual rework and denials by performing root-cause analysis and implementing best practices.

14. Provides expertise in the evaluation of new technology, services and programs.

15. Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.

KNOWLEDGE, SKILLS, ABILITIES

• Must have advanced revenue code, CPT and HCPCS coding knowledge.
• Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
• Solid understanding of multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.
• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff.
• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access.
• Possess effective oral and written skills, including superb formal presentation skills.
• Working knowledge of multiple healthcare applications, including but not limited to Epic, Med Assets, 3M and CDM maintenance software.
• Advanced knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD10, etc.) inclusive of associated edits such as NCCI.
• Well-developed research skills.
• Excellent organizational and project management skills.

Business Unit : Company Name

Piedmont Healthcare Corporate