Senior Revenue Cycle Analyst

Luminis Health

Title:  Senior Revenue Integrity Specialist     

Department:  Revenue Integrity

Reports To:  Director, Revenue Integrity

Cost Center/Job Code:  10000-50131-003004

FLSA Status: Exempt

Position Objective:

The Revenue Integrity Coding Specialist works in the Luminis Health Revenue Integrity department and serves as the key liaison and subject matter expert on all aspects of hospital charge capture and entry, charge integrity and charge reconciliation processes. This position will support and coordinate on-going charge capture and integrity improvement initiatives including charge reconciliation activities, new service implementation, third party payer audits, CDM audits, and identification of revenue management opportunities. They will align with clinical leadership and serve as the subject matter expert regarding billing compliance, accuracy of charge capture and integrity processes including education, audit activities, changes or risk of revenue (regulatory or coding changes) and monitoring of charge capture related metrics to minimize revenue leakage.

Essential Job Duties:

1. Manages and tracks all hospital 3rd party payer audits; performs defense audits and educates clinical departments on lost payment opportunities
2. Performs internal review of Revenue Cycle processes
3. Collects, disseminates and educates clinical departments on all state and federal billing/coding/charging updates
4. Provides charge capture education to clinical departments
5. Performs CDM audits in accordance with Luminis Health Chargemaster Review Policy
6. Proficient Use of Support Systems
7. Efficient utilization of billing system database to update, Charge Description Master (CDM);  ensures broad understanding of all areas of revenue cycle including pre-AR, actualized AR review and router logic
8. Ability to appropriately edit charges via Charge Router and document actions via notes in the Resolute billing system.
9. Demonstrated ability to utilize Outlook email and navigate in the Word and Excel software applications.
10. Competence in Coding, Billing and Charge Integrity Workflows
11. Evaluates current charging and coding structures in clinical, coding and Revenue Cycle departments to ensure appropriate capture and reporting of revenue and compliance with state/federal government and third-party payer requirements
12. Assess the accuracy and build of all Charge Capture related workflows in EPIC, including documentation, automation enhancements
13. Demonstrates the ability to understand and utilize payer rejections and remittance denials to execute denial management strategies in an effort to mitigate the risk of future denials.
14. Organizational Efficiency
15. Effectively maintains audit and account activity by ensuring the proper organization, tracking, filing and documenting of all correspondence.
16. Assists in proactive communication and root cause analysis of challenges impacting final adjudication of claims, including but not limited to system or payer issues
17. Provides Outstanding Customer Service 
18. Creates a cross-collaborate approach with, billing teams, Coding, HIM and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation and compliant billing of all charges.

Educational/Job Experience Requirements:

• BS in Finance, Accounting or Healthcare related field preferred
• In lieu of BS degree, 10 years of hospital Revenue Cycle/Revenue Integrity experience preferred
• 5-7 years experience supporting Revenue Cycle and Clinical systems
• Works well in environment with firm deadlines; results oriented
• Demonstrates strong knowledge of end to end revenue cycle
• Experience in EPIC required
• Experience with Microsoft Office, Word and Excel
• Ability to communicate professionally via internet and virtual communication tools

Required License/Certifications:

• Coding certification required (CPMA, CPC, CBCS or CCS)

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.