The Revenue Integrity Analyst is a technical expert relative to the Hospital’s Charge Description Master (CDM), with particular emphasis on hospital charge capture as it relates to charge audit, billing compliance, strategic pricing, and revenue protection. Under general supervision, the Revenue Integrity Analyst will develop, maintain and report on the Hospital CDM in order to optimize revenue generation, and maintain compliance with 3rd party payer requirements. This position provides training for departmental personnel relative to the charge capture process as well as supports clinical areas in the development of pricing for services and supplies in consideration of cost and market. This position also directs internal/external charge reviews and ongoing refinement of the Chargemaster through the coordination of chargemaster committee meetings comprised of key personnel from Business Services, Patient Access, Accounting, Finance, HIM, Compliance, IT, and all clinical areas.
Essential Functions
Responsible for managing, coordinating, and implementing all charge master (CDM) initiatives and
processes to ensure revenue management and protection.
Works closely with all clinical departments to maintain and educate for:
o Optimum charge capture and compliant billing
o Provides guidance to departments regarding strategic pricing of supplies and services
o Provides ongoing charge entry training and retraining as needed
Creates policies and procedures related to hospital charge practices
Studies, reports and makes recommendations relative to compliance concerns related to charge
practices
Evaluates departmental CDM requests to insure that all additions, changes and deletions are
consistent with proper hospital charge and coding practices
Analyzes and resolves specific billing edits/errors that require clinical expertise and that are delaying
claims for processing in Epic
Oversees charge integrity at the clinical department level by:
o Ensuring revenue routes to correct cost center
o Audits for missing charges
o Monitors late charges
Manages quarterly Chargemaster Committee meetings to address challenges related to Medicare
updates and charge capture opportunities
Serves as the principal point of contact for charging issues
Participates in bi-weekly Health System Revenue Integrity conference calls
Reports Epic charge-related issues for resolution
Directs onsite and remote external charge reviews
Works with regional CDM team on special requests and updates
Coordinates to Finance team any productivity (RVU) revisions as impacted by CDM changes
Perform other duties as assigned
Education, Training and Experience
Required:
3-5 years’ experience as an analyst in a healthcare environment with emphasis on
chargemaster, revenue capture, reporting and reimbursement
Preferred:
Bachelor’s degree preferred, in business administration, finance, accounting, or healthcare
administration
Skills or Other Qualifications
Required:
Applicant has a general understanding of Managed Care and Government reimbursement methodologies. General knowledge of hospital operations (Revenue Cycle: Registration, Patient Accounting/Billing, claim data processing).
Solid computer technical skills required, including proficiency with Microsoft Office products (Word, Excel, Access, and PowerPoint). Allscripts EPSI and EPIC knowledge a plus.
Proven excellent communication and customer service skills, including the ability to progressively investigate, analyze and identify sources of problems, provide practical solutions, and negotiate resolutions.
Ability to make independent business decisions, considering both the impact to client satisfaction and overall financial impact for the department and organization.
Ability to streamline processes for efficiency. Strong analytical aptitude and experience creating financial analysis. Possesses good sense of general business acumen.
Preferred:
Strong understanding of DRG and CPT/HCPC Medical Coding and Medical Terminology.
Basic understanding of Accounting Principles and Hospital Financial Reporting.
