Job Description - Revenue Integrity Analyst III - Remote (190#######)
Job Description Revenue Integrity Analyst III - Remote-190#######
As a part of the Tenet and Catholic Health Initiativesfamily, Conifer Health brings 30 years of healthcare industry expertise toclients in more than 135 local regions nationwide. We help our clientsstrengthen their financial and clinical performance, serve their communitiesand succeed at the business of healthcare. Conifer Health helps organizationstransition from volume to value-based care, enhance the consumer and patienthealthcare experience and improve quality, cost and access to healthcare. Areyou ready to be part of our solutions? Welcome to the company that gives you the resources and incentives toredefine healthcare services, with a competitive benefits package andleadership to take your career to the next step!
Responsiblefor researching, managing, coordinating, and implementing Charge DescriptionMaster ( CDM ) and charge capture initiatives and processes to ensure revenuemanagement and revenue protection. Ensures the overall integrity of the CDM.Conducts audit/review activities to ensure appropriate revenue management,claims production, and coding integrity. Research and maintains compliance withstate, federal, and other third-party payor billing and reimbursementguidelines. Conducts special projects and studies to facilitate revenuemanagement as required. Works independently; performs duties requiring theexercise of discretion and independent judgment; has ability to make decisionsafter comparing and evaluating possible courses of action; formulates, affects, interprets, orimplements management policies or operating practices; prioritizes and managesmultiple tasks to meet deadlines; seeks guidance from manager as needed toclarify assignments or requests, ask questions, or seek additional information.
ESSENTIALDUTIES AND RESPONSIBILITIES
Includethe following. Others may be assigned.
Researches, evaluates, and interprets guidancefrom a variety of sources to determine department and/or facility impact;continually reviews and monitors billing and coding changes affecting CDM andcharge capture processes, including price analysis.
Serves as a subject matter expert and in aconsultative role to various levels of customers including patient accountingsystems; works closely and collaboratively with other internal departments.
Reviews CDM change requests for accuracy andappropriateness; approves additions, deletions, and modifications to charges;imparts knowledge to facilities regarding requested changes
Provides guidance and education related tobilling and charge capture of services to multiple staff levels; facilitatesproper recording of transactions in compliance with state, federal, and otherthird-party payor guidelines.
Conducts special projects and special studiesto facilitate revenue management as required for system conversions, newfacilities/acquisitions, new departments, new service lines, changes inregulations, legal reviews, etc.
To performthis job successfully, an individual must be able to perform each essentialduty satisfactorily. The requirements listed below are representative of theknowledge, skill and/or ability required. Reasonable accommodations may be madeto enable individuals with disabilities to perform the essential functions.
Advanced knowledge of the accepted principles, practices andtools relating to general healthcare billing, cost accounting andreimbursement.
Advanced knowledge of policies, standards and methodologiespertaining to charge capture and reconciliation, reporting, documentation andgeneral compliance.
Advanced knowledge of the content and application ofpublished health information management coding conventions, e.g., as referencedin \"Coding Clinics\" and/or other nationally recognized codingguidelines.
Ability to recognize, research and correctcharging/documentation discrepancies.
Advanced knowledge of the standards and regulatoryrequirements applicable to matters within designated scope of authority,including medical/legal issues.
Advanced knowledge of medical terminology and abbreviations, andhealth care nomenclature and systems.
Abilityto use office equipment and automated systems/applications/software at anacceptable level of proficiency.
Abilityto establish and maintain effective working relationships as required by theduties of the position.
Strong interpersonal communication and presentation skills,effectively presenting information to management, facility groups, andindividuals.
Advanced knowledge of CPT/HCPCS codes, revenue codes.
Comprehensive knowledge of CMS laws, rules, and regulations governing CDM/CPT/Edits.
Ability to respond to complex inquiries in a professionalmanner.
Strong understanding of Revenue Integrity/Charge DescriptionMaster, its impact throughout the revenue cycle, and contribution to revenuemanagement.
Includeminimum education, technical training, and/or experience preferred to performthe job.
Experience Required: 5+ years of healthcare-related experience.
High School graduate or equivalent required.
College degree preferred.
Prior CDM or charge capture experience required.
Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, COC, CPC, CCS highly desirable
The physicaldemands described here are representative of those that must be met by anemployee to successfully perform the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel*
Includes ability to walk through hospital-based departmentsacross broad campus settings, including Emergency Department environments*
*May requirethese demands
The workenvironment characteristics described here are representative of those anemployee encounters while performing the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.
Office Work Environment
Hospital Work Environment
:Process & Analyst
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.