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Sr Revenue Integrity Analyst

Responsibilities

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PRIMARY FUNCTION:

This position plays a leadership role in improving the Jefferson Health's overall accuracy, integrity and quality of patient charges while ensuring minimal variation in charge practices. Responsible for collaborating with Revenue Cycle and Clinical Managers and above to ensure accurate and thorough analysis of governmental and commercial payer regulations related authorizations, coding and billing guidelines. Researches claim data variances, evaluates payer updates and performs chart-to-bill audits to produce and maintain timely, accurate and inclusive charge capture, coding and billing functions.

ESSENTIAL FUNCTIONS:
Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
With responsibility for all cost centers within service lines and acting with a high degree of autonomy, performs reviews related to Charge Description Master (CDM) integrity.
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, ensuring consistency across all entities.
Provides guidance, communication and education on correct charge capture, coding and billing processes to multiple clinical departments and entities.
Collaborates with Clinical, Revenue Cycle, Corporate Compliance, Health Information Management, Internal Audit and other Revenue
Assists clinical departments in resolving edits holding patient claims from billing by reviewing medical records and other applicable documentation.
Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines.
Reviews Charge Description Master change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges.
Prepares revenue cycle meeting materials and facilitates clinical service-line Revenue Cycle department meetings.
Collaborates with clinical department personnel to analyze Charge Description Master billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management.
Assists in the development and implementation of effective chargemaster review, education and training.
Reviews charge edit trends for documentation or charging issue opportunities.

Qualifications

EDUCATIONAL/TRAINING REQUIREMENTS:
Bachelor's degree in Health Information Management, Business Administration, Accounting, Management or Healthcare Administration.
Master's degree preferred.

CERTIFICATES, LICENSES, AND REGISTRATION:
Must hold and maintain one or more of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
Applicable professional certifications from American Association of Healthcare Administrative Management (AAHAM) or Healthcare Financial Management Association (HFMA) preferred.

EXPERIENCE REQUIREMENTS:
Five years experience in a hospital setting or within the healthcare industry strongly preferred.
3 - 5 years of experience related to auditing and/or coding is required. Clinical experience is preferred.
In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.
Understanding of multiple reimbursement systems including IPPS, OPPS and fee schedule.
Strong oral and written communication skills.
Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations.
Ability to document clinical workflows impacting revenue cycle.
Strong written communication, formal presentation skills, and excellent customer service skills.
High degree of comfort presenting to and interacting with senior levels of hospital management and with physician leaders.
Excellent organizational and project management s

Closing Statement

About Jefferson

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.