Senior Revenue Integrity Analyst - Revenue Integrity & Reimbursement

Minimum Qualifications: 

Bachelor’s degree or equivalent in Finance, Business Administration, Health Care Administration, Nursing, or related field and 4 years’ related experience required. 

Preferred Qualifications:

Bachelor's degree and/or Financial Analyst experience.

Job Summary:

Develops and tracks meaningful metrics and key performance indicators for SOM and Health System departments to ensure accurate and optimal revenue capture and reimbursement. Responsibilities include interpretation of complex metrics and reporting, and regular communication with departments and external stakeholders on performance and improvement areas. Utilize appropriate tools to support charge capture, revenue reconciliation, denial management, and payment validation. Serve as subject matter expert to Revenue Integrity Analysts.

Job Duties: 

Liaison:

• Coordinate with report writers to develop department-specific reporting on revenue and reimbursement trends, and analyze complex reports on an ongoing basis.
• Meet with department stakeholders to review reporting and assist with root cause analysis, and based on analysis, recommend workflow or system changes to improve performance.
• In conjunction with Revenue Cycle, Finance, and Health System/SOM leadership, assume responsibility for the adoption of reporting and metric targets by supported departments.
• Provide the data necessary to drive department accountability and achievement of metrics.
• Promote process standardization across related departments in order to improve revenue capture and reimbursement, and identify inconsistencies.
• Coordinate with IS on completion of any build or enhancements to the system to resolve technical issues related to revenue capture and reimbursement.
• Identify and ensure any necessary training is provided to end users in order to correct existing workflows or educate on new processes.
• Assist with strategic pricing, chargemaster maintenance, and charge capture reporting.

Denial Management:

• Coordinate with report writers to develop department-specific reporting on denials and avoidable write-offs, and analyze complex reports on an ongoing basis.
• Prepare, compile, and distribute denial and AWO reports, and present data to appropriate stakeholders including the HB and PB Denial/AWO Committees.
• Meet with department stakeholders to review reporting and assist with root cause analysis, and based on analysis, recommend workflow or system changes to improve performance.
• Provide trending on the types of claims denied and root causes of denials, and collaborate with team members to make recommendations for improvement and issue resolution.
• Maintain an updated issues list on behalf of the HB and PB Denial/AWO Committees, and follow up with owning areas as necessary to ensure progress and adherence to resolution plans.
• Coordinate with IS on completion of any build or enhancements to the system to resolve technical issues related to denial management.

Payment Validation:

• Maintain contract management system to ensure accurate and current contract terms.
• Perform financial analysis utilizing the contract management system to review overall payor reimbursement as compared to costs.
• Facilitate contract modeling and reimbursement impact analyses of proposed contract changes to support negotiations.
• Assess opportunities to maximize reimbursement by reviewing cost information, billing practices, and pricing strategies.
• Perform reviews of $0 balance accounts for the appropriate contractual reimbursement to ensure payment accuracy compared to expected allowables.
• Identify, resolve and escalate any major payment discrepancies or recurring errors at both aggregate and detailed level.
• Provide detailed reporting of payment variance opportunities, recoveries and trends for improving performance.
• Develop and maintain payor report card in order to assess overall performance of contracts.
• Contact identified payer sources to resolve problems or issues related to reimbursement.
• Provide frequent updates to leadership on contract performance, including risks to payor compliance with agreed-to contract terms, and current process improvement initiatives.
• Performs related duties as assigned. 

Knowledge/Skills/Abilities: 

• High level of customer service skills to establish and enhance positive relationships with clinical departments, Revenue Cycle, IT, Finance, and other stakeholder departments.
• Excellent ability to understand and interpret statistical reports and perform quantitative analysis.
• Advanced skills in problem solving in a variety of settings and translation of data into actionable steps.
• Knowledge and detailed understanding of insurance claim processing and third party reimbursement.
• Knowledge and detailed understanding of managed care fundamentals, including negotiated agreements and contract maintenance practices.
• Knowledge of multiple clinical disciplines and charging practices.
• Knowledge of the principles of Information Systems in order to effectively analyze and make decisions, preferably with proficiency in Epic.
• Knowledge of state and federal regulations as they pertain to billing processes and procedures.
• Knowledge of various types of provider reimbursement methodologies including per diems, inpatient DRG & APR DRG case rates, percent of charges, and outpatient surgery case rate methodologies such as ASC and OPPS as established by CMS.
• Familiarity with both commercial and government payors.
• Advanced analytical skills, including ability to provide thorough assessment of contract performance.
• Advanced computer skills to support analysis, data management and reporting
• Skill in time management and project management.
• Ability to work efficiently under pressure.
• Ability to deal effectively with challenging situations.
• Skill in effective oral, written, and interpersonal communication.
• Skill in time management and project management.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
• Ability to deal effectively with constant changes and be a change agent.
• Ability to willingly accept responsibility and/or delegate responsibility 

Salary Range: 

Actual salary commensurate with experience. 

Work Schedule: 

The position is mostly remote, however the individual must be readily available to travel to attend meetings, and other work-related in person activities as needed.  Monday through Friday, 8am to 5pm, and also as needed on occasion.