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Cooper University Health Care · 4 weeks ago

REVENUE INTEGRITY ANALYST - HYBRID

Camden, NJ

Full-time

Hybrid

Senior Level

5+ years exp

Cooper University Health Care is dedicated to providing extraordinary health care and is seeking a Revenue Integrity Analyst. This role is responsible for overseeing charge reconciliation processes, managing claim edits, and ensuring compliance with coding and charging guidelines to enhance revenue integrity across various departments.

Health CareInnovation Management

Responsibilities

Oversight of charge reconciliation process

Working charging related claim edits and Revenue Guardian checks in various Work Queues

Oversight of EPIC Charge Review Work Queues assigned to clinical areas (e.g., high dollar and high quantity charge)

Works with the PB and HB Denials teams to review and correct denials and edits related to charging and/or medical necessity

Coordinates PB and HB medical necessity denials educational calls

Works with the Revenue Integrity Nurse Auditors, UM/UR team and the Billing team to assist in response to external and internal coding and charging audits

Works with institute/department staff, Billing, Coding, Revenue Cycle Analysts, Claims Review Nurses, Clinical Documentation Improvement, and/or other relevant staff to correct conflicting coding, ambiguous documentation, and incorrect charging and charging practices

Performs charge capture and charging compliance audits in accordance with Revenue Integrity goals and/or workplan and on demand as assigned, initiating CDM requests and/or departmental education based on audit findings

Performance of root cause analysis relative to charging issues identified by charge edits, claim edits, denials, internal and external audits, or other instruments. Notes findings and report them to clinical, revenue cycle, and financial management. Initiates CDM request process for required updates by preparing request form (in excel or within the CDM tool as applicable) and forwarding to appropriate CDM Analyst

Assists the CDM Analysts as needed with the annual CPT change CDM update process

Coordinates quarterly HCPCS change CDM update processes when these changes do not pertain to charges originating from the Willow or Supply Chain systems

Assists with end user education for Craneware, monitoring Craneware requests, and obtaining any needed information for requests to be completed

Acts as charging Subject Matter Expert for assigned institutes, cost centers, and/or departments

Works with CDM Analysts to develop impact modeling related to CDM change requests as needed

Remains current on CMS, OIG, AMA, AHA, NJ Medicaid, and Commercial Payer regulations and/or guidelines related to coding and charging, including but not limited to CMS Final Rules and National Correct Coding Initiative regulations

Compiles and analyzes data from various sources to develop recommendations leading to potential revenue cycle opportunities, including analyses related to CDM set-up, charge capture, billing, and/or patient financial services

Works with the Revenue Integrity Manager and Analysts to communicate regularly with Revenue Cycle, Institute, Compliance and Financial leadership on trends in charging and coding accuracy, root cause of any inaccuracies, and potential compliance and/or financial risk

Reviews, develops, implements, evaluates, and revises charging guidelines to ensure compliant charging. Effectively implements recommendations and monitors results

Works with Revenue Integrity Manager, CDM Analyst, and Revenue Cycle Educators to prepare regular charging related education for their assigned institutes, cost centers, and/or departments

Assist management in examining processes to improve workflow

Conducts and leads special projects to facilitate revenue management as required for new facilities/acquisitions, new departments, new service lines, and changes in regulations

Complies with Cooper University Healthcare Policies and Procedures

Performs other duties as assigned by Leadership

Qualification

Revenue integrityCDM experienceAuditing experienceICD-10 codingCPT codingHCPCS codingEHR softwareMicrosoft OfficeCritical thinkingCustomer serviceProfessional demeanorCommunication skillsProblem solvingTeam collaborationTime management

Required

Minimum of five (5) years of healthcare experience with knowledge of hospital operations & payment systems

Experience working with CDM, coding, billing, clinical areas in charge functions, department support positions

Minimum of three (3) years of auditing, coding, CDM, revenue integrity, and/or revenue cycle management experience in a healthcare environment

Experience managing and resolving coding related billing edits (e.g., CCI, MUE, LCD/NCD, device to procedure, and procedure to device)

Understanding of CDM purpose/process, ICD-10, CPT, and HCPCS coding systems used in healthcare, financial management and reporting

Experience with EHR software and understanding of clinical documentation

Established knowledge of Medicare and Medicaid regulations

Able to review and understand various healthcare regulatory bulletins, websites, quarterly updates for communication to the hospital facility

Experience problem solving, using critical thinking skills to perform root cause analysis on complex issues developing elegant solutions

Proven ability to communicate, listens well, likes to investigate

Bachelor's degree from an accredited college in a relevant field of study

Coding certification (e.g., CPC, COC, CCS) from industry recognized certification organization (i.e., AAPC, AHIMA) must be current or obtained within one year of hire date

Proficient with Microsoft Office suite (e.g., Excel, Word, PowerPoint)

Ability to prioritize work and make frequent adjustments to priorities

Ability to manage multiple concurrent activities

Ability to learn computer and application skills as applicable to role

Ability to establish and maintain effective working relationships with patients, employees, and the public

Maintains a positive and professional demeanor

Acts in a respectful, supportive, and empathetic manner

Provides appropriate and timely responses to customer concerns or requests

Accepts responsibility for own work

Assists coworkers and helps with other duties as assigned

Participates in in-services and other functions

Ability to work effectively with all levels of management

Preferred

Experience with Epic

Report writing experience in Business Intelligence application

Experience supply-chain and/or pharmacy item add process

Benefits

Health, dental, vision, life, disability, and retirement

Company

Cooper University Health Care

Glassdoor3.6

Cooper University Health Care is the leading academic health system in South Jersey and provides access to primary, specialty, tertiary, and urgent care, all within one complete health system.

Founded in 1887

Camden, New Jersey, USA

10001+ employees