Revenue Integrity Analyst
St. Joseph’s/Candler Health System, New York, NY, United States
Overview
The Revenue Integrity Analyst assists and completes functions to ensure timely, compliant, and accurate capture of charges and correct claims to various payers including governmental and non-governmental payers. The role resolves pre-bill claim edits and Meditech account checks; reviews and enters accurate charges; completes charge corrections; and monitors, tracks, and reports claims and charge capture trends. The analyst must be knowledgeable and stay current with CMS regulations and managed care/commercial payer requirements and changes.
The analyst must apply billing and coding knowledge to complex claim scenarios to resolve them in a compliant and accurate manner and completes projects and other tasks as assigned by the department Director or designee.
Education
Associate's Degree – Required (Healthcare Preferred)
Bachelor's Degree – Preferred (Healthcare Preferred)
Medical Terminology – Required
Courses in computer technology, spreadsheets/project management, medical billing, and medical coding – Preferred
Experience
2 years of hospital revenue cycle charging, claims processing, professional and/or hospital healthcare billing, denials management or related revenue cycle/financial experience – Required for candidates with an Associate's degree
No Experience Required for candidates with a Bachelor's degree or Master's degree in Healthcare Administration, Health Sciences or related healthcare business field of study.
Effective problem solving and attention to detail – Required
Proficient in basic Excel, Word and PowerPoint – Required
Knowledge of hospital billing & claim requirements, charge capture processes, CPT codes, modifiers, and other claims data, electronic record documentation and payer requirements including Medicare guidelines – Preferred
Experience with CPT/HCPCS coding, claims preparation, MUE and NCCI claims edits – Preferred
License & Certification
Certified Professional Coder (CPC) or similar coding certification through accredited organization such as AAPC or AHIMA or Certified Revenue Cycle Professional/Specialist (CRCS) or Certified Revenue Cycle Representative (CRCR) through AAHAM or HFMA respectively – Required or must be obtained within 9 months of hire date.
Core Job Functions
Reviews and resolves pre-billing claim edits including National Correct Coding Initiative (NCCI), Medical Unlikely (MUE), and other assigned claim clearinghouse pre-billing edits daily to ensure compliance and accuracy.
Completes manual charge entry and patient account reviews as assigned, including charge entry and pre-billing auditing of emergency department visits & procedures, outpatient IV infusion and injection charges, blood administration charges, and other inpatient, outpatient or observation patient services/charges.
Resolves account checks in Meditech daily to ensure timely submission of claims to payers including government and non-governmental payers.
Identifies charge capture trends and claim edit trends and provides analysis and suggestions to improve clean claims submitted to Revenue Integrity leadership.
Assists co‑workers in the department with other daily or weekly responsibilities as assigned, including resolution of Meditech account checks, patient account tasks, floor charges, quality report exceptions, and other items.
Completes charge audits to include post‑claim reviews in the Trisus Claims Informatics (TCI) tool and other tools.
May be assigned other duties to support timely, compliant, and accurate billing of patient services/charges or resolution of charge‑related denials/claim rejections.
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The Revenue Integrity Analyst assists and completes functions to ensure timely, compliant, and accurate capture of charges and correct claims to various payers including governmental and non-governmental payers. The role resolves pre-bill claim edits and Meditech account checks; reviews and enters accurate charges; completes charge corrections; and monitors, tracks, and reports claims and charge capture trends. The analyst must be knowledgeable and stay current with CMS regulations and managed care/commercial payer requirements and changes.
The analyst must apply billing and coding knowledge to complex claim scenarios to resolve them in a compliant and accurate manner and completes projects and other tasks as assigned by the department Director or designee.
Education
Associate's Degree – Required (Healthcare Preferred)
Bachelor's Degree – Preferred (Healthcare Preferred)
Medical Terminology – Required
Courses in computer technology, spreadsheets/project management, medical billing, and medical coding – Preferred
Experience
2 years of hospital revenue cycle charging, claims processing, professional and/or hospital healthcare billing, denials management or related revenue cycle/financial experience – Required for candidates with an Associate's degree
No Experience Required for candidates with a Bachelor's degree or Master's degree in Healthcare Administration, Health Sciences or related healthcare business field of study.
Effective problem solving and attention to detail – Required
Proficient in basic Excel, Word and PowerPoint – Required
Knowledge of hospital billing & claim requirements, charge capture processes, CPT codes, modifiers, and other claims data, electronic record documentation and payer requirements including Medicare guidelines – Preferred
Experience with CPT/HCPCS coding, claims preparation, MUE and NCCI claims edits – Preferred
License & Certification
Certified Professional Coder (CPC) or similar coding certification through accredited organization such as AAPC or AHIMA or Certified Revenue Cycle Professional/Specialist (CRCS) or Certified Revenue Cycle Representative (CRCR) through AAHAM or HFMA respectively – Required or must be obtained within 9 months of hire date.
Core Job Functions
Reviews and resolves pre-billing claim edits including National Correct Coding Initiative (NCCI), Medical Unlikely (MUE), and other assigned claim clearinghouse pre-billing edits daily to ensure compliance and accuracy.
Completes manual charge entry and patient account reviews as assigned, including charge entry and pre-billing auditing of emergency department visits & procedures, outpatient IV infusion and injection charges, blood administration charges, and other inpatient, outpatient or observation patient services/charges.
Resolves account checks in Meditech daily to ensure timely submission of claims to payers including government and non-governmental payers.
Identifies charge capture trends and claim edit trends and provides analysis and suggestions to improve clean claims submitted to Revenue Integrity leadership.
Assists co‑workers in the department with other daily or weekly responsibilities as assigned, including resolution of Meditech account checks, patient account tasks, floor charges, quality report exceptions, and other items.
Completes charge audits to include post‑claim reviews in the Trisus Claims Informatics (TCI) tool and other tools.
May be assigned other duties to support timely, compliant, and accurate billing of patient services/charges or resolution of charge‑related denials/claim rejections.
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