Full Job Description
Position Summary:
This position contributes and supports Revenue Integrity's mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and the charge improvement process. It is an integrated approach that guides the Hartford HealthCare (HHC) organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. This role supports HHC outpatient departments that includes hospitals services for a variety of revenue generating clinical departments.
Under the direction of the Manager Revenue Integrity Analyst - Clinical Liaison , the Revenue Integrity Analyst II plays a key role in tasked with improving revenue results. This position is integral to the Revenue Integrity Team to assist in ensuring charging accuracy, for patient services and appropriately coded supported by clinical documentation so the related revenue is recorded in the proper department. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed.
This position requires highly technical coding skills with an emphasis in billing to handle complex outpatient hospital accounts. Requires having regulatory knowledge as it related to hospital outpatient services. Familiarity with Medicare's OPPS payment system.
This position is responsible for assisting Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.
Position Responsibilities:
Key Areas of Responsibility
1. This position contributes and supports Revenue Integrity's mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and the charge improvement process. Under the direction of the Revenue Integrity Manager, the Revenue Integrity Analyst II plays a role in a tasked with improving revenue results. Analysts evaluate current charging and coding structures and processes in revenue generating departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements. Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, and other charge documents used to capture revenue.
2. This position is responsible for assisting Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. Performs denial resolution by analyzing denial data to identify root causes of preventable denials, develop and implement corrective action plans to address root causes, including collaborating with the clinical areas as well as other departments within revenue cycle. Optimizes revenue cycle processes by validating, evaluating, and trending substantial amounts of data for presentation to all levels of the organization.
3. This position serves as an audit outcome educator with clinical staff in clinic and department settings. Performs regular charge audits, identifying any trends, and implementing corrective actions when appropriate reporting to the Revenue Integrity Manager. Provides guidance, communication and education on correct charge capture, documentation, coding, and billing processes.
4. Performs an integrated approach toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. In turn, this promotes revenue enhancement and compliance with laws and regulations with feedback and education to the hospital departments as needed. Evaluates current charging and coding structures and processes in revenue generating departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements. Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents used to capture revenue.
5. This position is integral to the Revenue Integrity Team to assist in ensuring patient services are accurately charged, appropriately coded, supported by clinical documentation and that the related revenue is recorded in the proper department. This position is responsible for assisting Revenue Cycle Services, Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials, participating in external audit requests, and special projects as needed.
6. Communicate CDM maintenance activities to clinical departments and information systems staff to implement necessary changes that affect charge identification, capture, reconciliation, and claim processing. Ensure changes within the charge description master (CDM) coincide and are implemented with clinical systems by reviewing flow sheets or charge capture preference lists. Leads annual, quarterly, CPT®, HCPCS changes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement.
7. Monitor national, state, and local information to keep current with applicable regulatory and legislative changes and tailor the revenue integrity program accordingly.
8. Leads and participates in projects and other duties related to revenue cycle initiatives and duties. Includes training new analysts.
Working Relationships:
Job Title of Individual(s) Reports To: Manager, Rev Integrity Analyst - Clinical Liaison
Qualifications:
Education
• Minimum: Bachelor's degree with health management or financial emphasis and/or health services or equivalent experience.
Preferred: Bachelor's Degree or equivalent Healthcare experience.
Experience
• Ten (10) years of progressive on-the-job coding and health care experience in an acute care hospital.
Licensure, Certification, Registration
• Minimum: Certified Coder, (CCS, CPC, etc.)
• Preferred: Certified Healthcare Revenue Integrity (CHRI)
Language Skills
• English - Strong written and verbal communication skills
Knowledge, Skills, and Ability Requirements:
Project work:
• Requires the ability to manage large complex projects assignments, investigate, analyze, and resolve issues at an important level. Excellent communication, presentation, organizational, analytical, and critical thinking skills.
• Must approach problem-solving challenges independently, have strong attention to detail and enjoy working in a fast-paced, collaborative team-based environment.
Proficiencies:
• Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, and Ras.
• Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10.
• Extensive knowledge of NCCI edits, and Medicare LCD/NCDs.
• Extensive understanding of reimbursement theories to include OPPS, MPFS, and managed care.
• Extensive working knowledge of health care compliance.
• Extensive understanding of medical terminology, anatomy, and physiology along with clinical department activities. The ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with assistance for all member entities.
• The ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership, and other billing personnel.
Skills:
• Read, write, and speak English proficiently.
• Strong analytical capabilities.
• Excellent organizational skills.
• Proficiently read and interpret physician writing.
Strong ability to:
• Function independently.
• Manage multiple priorities.
• Listen and acknowledge ideas and expressions of others attentively.
• Converse clearly using appropriate verbal and body language.
• Collaborate with others to achieve a common goal through cooperation.
• Influence others for positive and productive outcomes.
• Utilize coding subject matter expertise to support new specialized coders and other projects.
• Work across the Hartford HealthCare System.
Computer skills:
• MS Office includes Word, PowerPoint, Excel and Outlook, Windows operating system, and the Internet.
