Revenue Integrity Analyst

Summary:

The Revenue Integrity Analyst will work under the direction of the Manager of Revenue Integrity to meet financial objectives by identifying and evaluating trends, analyzing variances, monitoring and identifying opportunities for revenue and reimbursement maximization. This position requires an expert level of Managed Care, payor contracts, regulations and policies, a high-level of analytical skills and problem-solving skills with the ability to evaluate effectiveness of workflows and systems, identify weaknesses and develop innovative solutions and process improvements. Must have strong attention to detail and able to have initiative, work and manage projects independently and communicate effectively with all areas within the organization, as well as organizational and priority setting abilities. 

Responsibilities:

Perform various functions including providing support and analysis by querying appropriate data, preparing reports, making presentations of analysis, findings, and recommendations to management. Identify payment variances based on expected reimbursement from contracted managed care payors, government payors and non-contracted miscellaneous payors. Engage and provide necessary data to consultant and assist with contract negotiations.

Research and understand changes in the healthcare regulatory environment and the potential impact on reporting. Staying abreast of payer and regulatory updates.

Support Revenue Integrity Manager in financial modeling, identifying underpayment trends and coordination of data and communication to Managed Care Team. Conduct updates and maintenance of contracts including but not limited to rate fee schedules by client specific instructions. Work with IT to maintain Epic Managed Care model accurate and up to date.

Monitor, analyze, identify trends and report zero payments and work closely with Patient Financial Services on Denials.

Provide support to the Chargemaster Analysts and Charge Capture Analyst with projects, identifying missed opportunities, denials, and accounts within Work queues.

Responsible to adhering CMS regulations for Price Transparency, Shoppable Services, Patient Estimates to include maintaining current in Epic and working closely with Patient Financial Services and Patient Access.

Lead efforts to assess, modify, and/or develop and implement more timely and consistent processes/systems to increase efficiency, accuracy and meaningfulness of information related to Managed Care and Price Transparency.

Perform audits and reviews, identify issues, risks, opportunities and optimizations and propose resolutions to include process improvement and/or development. Reports back to leadership and provide education and support.

REQUIRED: 3+ years related experience

REQUIRED: Associate degree- Business Admin/Other

Work Schedule: 8-hours, Days, Monday through Friday

Physical Requirements and working conditions for this position will be provided to you upon interview.