RN Revenue Integrity Analyst

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Interacts with clinical department directors to monitor charge capture functions across all entities.
• 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.
• Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
• Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities.
• Monitors EPIC Revenue Integrity Dashboard(s)
• Participates in moderately complex projects related to revenue integrity initiatives.
• Provide support for assigned cost centers within service lines
• Participates in analyzing changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Train and assist clinical team with revenue integrity functions.
• Performs miscellaneous duties as assigned.
• Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
• Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders.
• Excellent organizational and project management skills.
• Strong time management, attention to detail, and follow through.
• Well-developed research skills.
• Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
• Work effectively as a team contributor on all assignments.
• Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
• Delivers positive patient experience, where applicable.

EDUCATION & EXPERIENCE

Bachelor of Science in Nursing degree and +three (3) years of experience within the revenue cycle. Experience above minimum requirement will be considered in lieu of education.

Experience: In excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; hospital leadership. Clinical leadership experience preferred with high level focus charges/revenue. EPIC HB/PB experience preferred. Knowledge of CPT/HCPCS procedural coding preferred.

CERTIFICATION/LICENSURE

Licensed as an RN in state of practice

Approved CPR or BLS certification required within 90 days (Other certification per unit requirements: ACLS, PALS, PEARS, NRP)