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Revenue Integrity Analyst

Job ID 149440 Date posted 08/01/2018

Position Summary:
Under the managerial oversight of the Director or Manager of Revenue Integrity the Revenue Integrity Analyst serves as a primary point of contact for Service Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, hospital colleagues and others regarding matters that relate to aspects of professional and hospital revenue charge capture and other matters relating to professional and hospital revenue cycle and modality specific billing processes and/or workflows.. The Revenue Integrity Analyst is responsible for educating providers, clinical colleagues and other members of their assigned modality specific revenue cycle teams regarding accurate professional and facility billing and revenue capture while adhering to CMS and third party payer regulations. The Revenue Integrity Analyst is responsible for assisting in the implementation of new revenue capture procedure records within the hospital chargemaster (CDM) and the development of workflows to ensure timely and accurate capture of all Lahey Health System revenue. The Revenue Integrity Analyst seeks to improve workflow, efficiency, accuracy, reimbursement and overall revenue cycle billing through operational and system enhancements and/or modifications. The Revenue Integrity Analyst is responsible to ensure that Lahey Health is maximizing accurate gross revenue capture to ensure maximum net revenue reimbursement is attained, sustained, and supported.

Essential Duties & Responsibilities including but not limited to:
- Responsible to provide a high level of all-around Revenue Cycle support for professional service on and off site locations staff, hospital facilities clinical staff, PFS professional and hospital billing staff, Epic system analyst colleagues, Finance leadership, and Revenue Cycle Leadership.
- Required to be available for Ad hoc PFS representation at interdepartmental, finance, and/or various onsite/offsite department revenue cycle meetings to assist with the evaluation of charge capture workflows and make recommendations to improve the accuracy and efficiency in capturing professional and facility revenue.
- Responsible to analyze, communicate, and draft internal controls and operational changes to comply with complex changes to government and third party payer policies, regulations and contract changes.
- Responsible to monitor and analyze various monthly/weekly/daily revenue and late charge reports. Responsible to monitor and analyze daily/weekly/monthly WQ data including Revenue Guardian holds, Charge Review, Router Review, and Claim Edits in order to make recommendations to correct any negative trends, high volume failures, and to improve front end work flow and procedures for both professional and clinical areas.
- Responsible to work closely with Epic system analysts within all charge capture modules in the upgrading, testing and implementation of any and all revenue cycle software products that impacts revenue capture, claim scrubbing, while ensuring Lahey Health adheres to compliance regulations set forth for both professional and hospital billing
- Responsible for the monthly production and maintenance of reporting mechanisms detailing departmental productivity and assist in the development, implementation, training and education, maintenance, and reporting of revenue capture initiatives.
- Responsible to remain current on new services being performed throughout the Healthcare System in order to maximize revenue capture. Has full knowledge of chargemaster maintenance policies and procedures in order to perform internal audits.
- Responsible to actively participates in the development and maintenance of revenue capture in electronic systems and any documents including downtime encounter forms (i.e,charge tickets). The Revenue Integrity Analyst assists in coordinating and maintaining accurate revenue capture preference lists containing charge code record selections with members of the modality specific professional and/or clinical staff.
- Responsible for keeping abreast of all government and payor level coding, billing, reimbursement rules, regulations, and guidelines related to professional and hospital revenue capture and billing. Responsible updating Epic system and informing SLD, Dept Managers, and other leadership of significant changes in a timely manner.
- Responsible to participate in complex projects and or audit related to revenue initiatives and complex investigations into allegations of fraudulent billing or abuse, as necessary. Provides support for projects in which Senior Leadership is involved
- Responsible to develop, trend, and report monthly and annual statistical reporting dashboard data to coincide with departmental and organizational KPIs (Key Performance Indicator).
- Responsible to proactively identifies problems or opportunities for improvements related to clinical orders,clinical documentation, and preference lists that are or should be linked to professional and/or hospital charge records. Makes recommendations to management and/or the perspective departments where high volume/high dollar values have been determined and creates Epic remedy tickets for improvements/changes to take place.


Education: Associates Degree
- In the absence of an Associate?s Degree preferably in the business or finance field, an additional 4 years of healthcare revenue cycle experience above the five identified below are required.

Licensure, Certification & Registration:
- Epic proficiency or certification in Charge Description Master

- Requires minimum 2 years of healthcare revenue cycle experience

Skills, Knowledge & Abilities:
- Comprehensive working knowledge of medical/hospital billing practices, billing software, health care insurance, and CMS regulations
- Knowledge of CPT, HCPCS, and ICD-10 coding principles.
- Knowledge of Epic or related hospital ADT/Billing software.
- Thoroughly proficient in data entry using a pc and a variety of electronic systems.
- Ability to read, analyze and interpret financial reports.
- Ability to define problems, collect data, establish facts and draw conclusions, and make sound recommendations.
- Capacity to analyze and think creatively and weigh alternatives.
- Perception of people and an awareness to deal with conflict successfully and attain resolution
- Demonstrates attention to detail.
- Demonstrates excellent organizational skills.
- Demonstrates skills with multitasking
- Demonstrates proficiency in the use of excel documents



About Lahey Health

The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

How To Apply

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