Intermediate Revenue Integrity Analyst

Primary City/State:

Mesa, Arizona

Department Name:

Ambulatory Revenue Integrity

Work Shift:

Day

Job Category:

Revenue Cycle

A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today.

Revenue Integrity has become a leading national focus to gain greater visibility for sound financial outcomes/practices, compliance and optimal reimbursement with focus across all continuums of patient care. Revenue Integrity in an integral part of the Revenue Cycle and covers all essentials related to it. We have teams comprised of Charge Capture, Pre-bill, Post-bill and Monitoring (Auditing). RI also utilizes technology to enhance achievement along with an added focus where necessary that may include high dollar accounts, denials, improved A/R days and cash flow while collaborating with many areas such as Billing, Coding, CDM Services Expected reimbursement.

We are excited to expand our team. The Intermediate Revenue Integrity Analyst will investigate missing professional charges. They will also identify any root causes of errors.

Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you’ll find many options for contributing to our award-winning patient care.

POSITION SUMMARY

This position, under the direction of the Revenue Integrity Director, is responsible for managing, coordinating, and implementing charge capture initiatives and processes to improve revenue management and revenue protection. This position is responsible to discover revenue issue root cause and to develop correction action plan and provide charge capture education. In addition, recommend modifications to established practices and procedures or system functionality as needed to support revenue cycle and manage implementation of the recommended changes. This position will work with internal customers to ensure newly implemented workflows and procedures support revenue cycle integrity and to achieve revenue cycle’s financial goals.

CORE FUNCTIONS

1. Acts as liaison between physician practices and coding to provide oversight and communicate provider charge capture performance. Closely aligns with physician coding to support the physician practice in achieving a healthy revenue stream. Partners with Coding, Cerner Clinical Informatics and Revenue Cycle teams to ensure an uninterrupted revenue cycle and support performance improvement opportunities.

2. Partners with physician practice leaders to provide oversight on open encounters and unsigned orders for a positive impact on timeliness of charges and ultimately the revenue cycle. Ensures new lines of service are communicated and set up proactively. Coordinates department requested CDM charge additions and deletions as applicable.

3. Identifies areas of risks and opportunities to improve compliance and revenue management. Monitors and resolves audit work queues, proactively identifies revenue opportunity and suggests improvements. Maintains knowledge of current coding and documentation requirements as required for compliant billing.

4. Collaborates with Clinical Informatics to provide feedback, training and education to providers regarding standardized charge capture workflows. Develops automated processes to replace manual workflow when able.

5. Provides guidance and education to departments as a subject matter expert on compliant charge capture and charge reconciliation. Provides revenue integrity training to new practice leaders and on an ongoing basis to ensure charge reconciliation procedures are being followed, assisting the practice leader with issue management and resolution.

6. Collaborates with Revenue Integrity Director to develop and generate standardized reporting templates for revenue integrity KPI dashboard and daily/weekly analytics. Analyzes and quantifies analytics dashboard results. Prepares timely and accurate reports for presentation to departments, senior leadership, Revenue Integrity and Continuous Improvement forums to support prevention of lost revenue. Escalates variances and collaborates with stakeholders for resolution and process improvement as indicated.

7. Reviews charging performance against standards and trends. Works with stakeholders to identify root cause and implement solution to remediate charge capture issues. Works with a variety of departments including senior leadership, physician practice, finance, coding, and revenue cycle to assist with data gathering and/or interpretation. Ensures the integrity of reports and databases used for Revenue Integrity.

8. Provides support for special projects assigned to the department by management for analysis. Brings strength in logic and analysis of data, sorts through data and determines which elements are pertinent to the project. Identifies and recognizes trends, presents data and analysis results to appropriate parties.

9. Works independently under general supervision and direction of the Revenue Integrity Director. Collaborates with Physician Department Leadership, Administration, Data Operations, Finance, Patient Access Services, Coding, and Patient Financial Services. Provides management with accurate and timely information necessary to effectively manage financial operations. Uses specialized knowledge and independent judgement to analyze information and solve problems. Researches complex charging/billing issues and provides education and recommends process improvements to ensure compliant charge capture and reimbursement. Work output has a significant impact on physician group revenue and department goals. Customers include physicians, nurses, coders, third party payors, central billing staff, and patients/patient families.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent’s immediate manager.

MINIMUM QUALIFICATIONS

Requires a Bachelor’s degree in Business, Finance, Health Management or related field or equivalent experience.

Requires a proficiency level typically attained with 3-5 years of experience in healthcare related work in a clinical, medical office or acute care setting. Must be knowledgeable of medical terminology and current regulatory agency requirements for coding and have a good understanding of reimbursement methodologies. Must have excellent analytical and organizational skills and the ability to manage multiple priorities with changing needs and deadlines. Requires excellent human relations skills and the ability to effectively interact and communicate both verbally and in writing with all levels staff and outside professionals.

Requires strong abilities in analysis, data interpretation, computer software applications, database and spreadsheet programs, plus a proficiency in generating management reports, projections, allocations, and analyses.

PREFERRED QUALIFICATIONS

Preferred licensure includes coding credentials (e.g. CCA, CCEP, CCS, CCS-P, COC, CHC, CHFP, CPC, CRCM, RHIT, etc.).

Additional related education and/or experience preferred.