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About the role
- Revenue Integrity Analyst optimizing Revenue Cycle for Virtua Health. Conducting root cause analytics and audits to identify process improvements and related opportunities.
Responsibilities
- The position is responsible for root cause analytics along with audits to help identify opportunities, issues, and process improvement within the Revenue Cycle.
- This role supports the revenue cycle workflows, charge capture, workqueue and denial review processes within an Epic based EMR.
- This position will help optimize Revenue Cycle by evaluating, validating and trending data for presentation to all levels of the organization.
- Will support the Virtua Hospitals, Physician Groups and Home Health.
- Perform quantitative and financial analysis along with audits designed to identify opportunities for improvement across the full spectrum of the Revenue Cycle.
- Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payor needs.
- Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
- Works with revenue producing departments to ensure the ongoing coordinated consistency of the charge master and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
- Conduct analytical reviews determine net revenue effect of proposed charge master and fee schedule changes.
- Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.
- Incumbent must develop close working relationships with management and staff in Revenue Integrity, Finance, Information Technology and Revenue and Clinical Operations allowing them to perform deep-dive analysis and reviews assisting with the identification of trends, solutions and potential corrective action steps.
- Will work both independently and have a high level of self-directed work efforts as well as be an integral part of the Revenue Integrity Team. Revenue Cycle will include areas from Hospital, Physician and Home Health.
- Monitor and assists with review of revenue cycle workqueues in Epic.
- Perform analysis to identify issues, trending, root cause, and action plan development with workqueue issues.
- Assist in strategic pricing process to optimize reimbursement within budget guidelines.
- Participate in ongoing coordination and resolution of revenue issues as they arise.
- Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations.
- Provide guidance and communication and collaborate with Revenue Integrity Team, Clinical Operations and IT to help ensure workqueue rules are accurate and updated based on annual and quarterly coding changes.
- Assist with Epic performance reporting, including assisting with Revenue & Usage, Enterprise Charge Reconciliation and Volume Reports.
- Workqueue and reporting will include areas from Hospital, Physician and Home Health.
- Serve as resource to Patient Financial Services staff for reporting problems and denials on individual claims.
- Assist in researching coding issues, provide guidance and recommend solution to account representative.
- Analyze billing errors and denial data to identify root cause of issues.
- Work with Revenue Integrity Team, Clinical Operations and Patient Financial Services staff to implement corrective actions to ensure compliant charges, prevent future rejections/denials and accurate and reimbursement.
- Claim issues and denials will include areas from Hospital, Physician and Home Health.
- Lead and participate in projects related to Revenue Cycle initiatives.
- Participate in ongoing coordination and resolution of revenue issues as they arise.
- Provide input to Director and Manager for annual Revenue Integrity planning process.
- Assist with additional projects as needed for Hospital, Physician and Home Health.
Requirements
- 3 to 5 years experience within a large hospital or integrated healthcare delivery system
- Ability to work collaboratively across disciplines and business lines
- Exceptional oral/written communication skills and highly customer-focused
- Excellent interpersonal and presentation skills
- Able to communicate with many, various customers
- Ability to prioritize, plan and execute
- Excellent critical thinking, analytical skills
- Bachelor Degree, in Accounting, Finance, Healthcare preferred
- EPIC Revenue Integrity, Hospital Billing, Physician Billing Certification, preferred
Benefits
- medical/prescription, dental and vision insurance
- health and dependent care flexible spending accounts
- 403(b) (401(k) subject to collective bargaining agreement)
- paid time off
- paid sick leave as provided under state and local paid sick leave laws
- short-term disability and optional long-term disability
- colleague and dependent life insurance and supplemental life and AD&D insurance
- tuition assistance
- employee assistance program that includes free counseling sessions
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