SENIOR REVENUE INTEGRITY ANALYST - Payor Contracting

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.

The Sr. Revenue Integrity Analyst team responsible for improving the quality of the revenue cycle function through the development of policies, the performance of compliance and contract payment audits, reporting and CDM management.   

• Analytical support: Analysis of available data to support the Revenue Cycle Integrity team initiatives in defining and identification of end-user deviations and other inconsistencies. This will involve qualitative and quantitative system and user analysis to identify technical or operational issues and areas for optimization.

• CDM management: Ensure the appropriate assignment of CPT/HCPCS codes, revenue codes, department codes, cost centers, service centers and prices. Obtains and compares data from multiple sources and reviews for discrepancies using various applications. Identify potential billable services, procedures, supplies, and/or pharmaceuticals that may be added to the CDM. Ensure CDM items are accurately synchronized with ancillary systems. Perform annual CDM review to identify deleted, added or modified service items. Process request to add, delete or modify CDM items in adherence to internal policy and guidelines. Ensure CDM additions, inactivation, and revisions are provided to information systems for implementation into the consortium clinical and financial systems. Perform/assist in charge capture testing between Cerner and ancillary systems to ensure desired outcome.

• Contract auditing: Ensure accuracy of contracted payor payments consistent with negotiated contracts through sampling and auditing of settled encounters.

• Denials management: Utilize Denials Analysis to identify root cause of issues driving controllable denials and partner with finance leadership to address operational issues driving controllable denials.  Provide feedback on erroneous payor denials to finance leadership and billing vendor to ensure timely appeals.

• Quality assurance and validation: Including analysis for new services or locations, revenue stream and revenue optimization, special program evaluation and validation, and other issue identification and solution development in highly complex situations.

• Training and education: Provide education to patient revenue generating departments/providers to ensure appropriate capture. Educate departments as new services are added, deleted, changed and/or revised. Ensure billing compliance through the knowledge of each departments work flow, charge capture process and system capabilities. Coordinate and conduct departmental interviews throughout the year to address charge capture related issues (i.e. department volume and revenue, accuracy of charge selection, denials, timeliness of charge entry, system inefficiencies).

• Reporting: Responsible for creating standard dashboards, reports and queries as needed by the Manager and Director to assist in the standardization of CDM related processes. Performs analytical and special projects, prepares ad hoc reports/data queries as may be assigned by the Director. Support annual consortium responsibilities pertaining National Data Warehouse data submissions and internal reporting regarding output reports from NDW data (i.e. user population, workload, hospital census, etc.)

• Other duties: Plans work activities, establishes priorities, and reprioritize work as directives change to meet scheduled deadlines. Participates in development and updating of organization procedures and update of forms and manuals. Performs a variety of other duties as assigned.

Education

• Bachelor Degree or an equivalent combination of education and/or work in Revenue Cycle/CDM

Experience

• 5 years minimum in hospital or physician billing office
• Prior experience with CDM maintenance
• Experience and knowledge of hospital charging practices and the revenue cycle flow in hospital financial systems
• Experience with inpatient and outpatient billing requirements of UB-04 & 1500 billing forms
• Knowledge of Cerner Revenue Cycle, PowerChart, other supportive applications and user workflows from Scheduling through account closure.

Certifications and Licenses:

• AAHAM Certified Revenue Cycle Specialist (CRCS), preferred
• AAHAM Certified Revenue Integrity Specialist (CRIP), preferred

Knowledge, Skills & Abilities

Preferred knowledge of:

• Finance related data migration, logic, and user workflows from encounter scheduling through account closure within the relational database Model.
• Knowledge of HL7, interface methods, dataflow within the Relational Database Model
• Knowledge of accounts receivable and billing/collection practices for IHS, CAH, FQHC, Provider Billing
• Knowledge of CPT, HCPCS, revenue code assignment
• Knowledge of payer edits, rejections, rules, and how to appropriately respond to each
• Knowledge of specific system and payer requirements required for billing

Skills:

• Highly proficient in relevant computer applications including Microsoft Office programs, Word, Excel manipulating large datasets (500,000+), Cerner and other electronic records applications.
• Critical thinking skills (problem solving, troubleshooting)
• Creative and comprehensive approach to designing workflow and system fixes
• Self-motivated with good organizational skills
• Excellent analytical skills and creative problem solving skills
• Good communication skills both orally and written
• Demonstrated proficiency with timely and successful appeals to insurance companies

Ability to:

• Develop new methods to define and identify statistical outliers
• View issues from technical, operational, and clinical perspectives
• Perform data reconciliations and analysis
• Act as the lead revenue integrity analyst and annual updates with stakeholders in field
• Conduct Department interview and partnerships
• Detail oriented and able to deliver neat and organized work
• Demonstrate initiative, excellent time management skills, and organizational capabilities
• Work on different projects simultaneously, work in fast paced setting and multitask in a fast paced environment and appropriate handle overlapping commitments and deadlines
• High level of collaboration within cross-functional teams
• Complete data entry for a lengthy amount of time
• Analyze and interpret insurance explanation of benefits
• Accurately identify the cause of rejections/denials and selection of appropriate action