Revenue Integrity Analyst

Job Description

The Revenue Integrity Analyst quantifies trends and identifies and measures opportunities to increase net revenue. Assists with source identification and root cause resolution of denials and payment variances, including underpayment analysis and management. This position is responsible for identifying potential charge capture workflow enhancements and calculating consistent charge structure methodologies according to industry standards and payer contracts. The RI Analyst will also interpret and manage a variety of metrics and reports, communicating regularly with departments and external stakeholders about operational and technical improvement areas to optimize revenues and ensure integrity and compliance in our charging and billing practices. A high degree of customer service skill is required to establish and enhance positive relationships within Revenue Integrity, Revenue Cycle Operations, EIS (IT), Finance, Clinical staff, and other stakeholder departments. Duties include:

• Conducts routine charge capture and reconciliation quality control audits. Re-audits workflows and processes if compliance opportunities are identified. Escalates instances requiring corrective action to departmental leadership.

• Manages and monitors system-wide charge audits process utilizing reporting data and tracking tools. Analyzes audit findings for improvement opportunities, recommends and facilitates process enhancements.

• Regularly monitors and reviews existing billing workflows, inputs and outputs. Independently works with the appropriate team(s) to adjust processes and systems to mitigate revenue leakages and optimize efficiencies.

• Is responsible for partnering with multiple stakeholders such as PBS, EIS (IT), clinical operations, clinicians and others to monitor revenue flows and identify improvement opportunities within various charge capture systems to facilitate the accuracy and integrity across revenue-generating departments.

• Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for Revenue Cycle and service line leaders; uses denials and revenue data to support findings.

• Works independently to manage quarterly and annual fee schedule maintenance work and special projects. Reviews existing and new charges to ensure they accurately reflect services/supplies provided and are consistent with industry best practices. Recommends new codes for fee schedule inclusion based on audit findings, staff requests and code updates.

• Collaborates with key constituents in different functional areas to create charge capture/reconciliation and billing reports that meet the organization's requirements and trains individual departments on how to properly generate and monitor such reports.

• Uses independent judgement to analyze changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable charging and billing guidelines. Stays apprised of payer and/or regulatory updates and is responsible for communicating changes to leadership and impacted areas. Take the lead in coordinating with EIS (IT) to upload changes timely.

• Collaborates with revenue integrity & revenue cycle compliance leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement; may also coordinate or deliver revenue integrity and PBS staff training.

• Participates in new business initiatives by researching appropriate billing codes, reimbursement and payer policies. Act as Revenue Cycle Compliance representative to research, approve and facilitate implementation of changes.Manage the intake and fulfillment of all pricing queries and fee schedule maintenance requests for the medical network.

Qualifications

Requirements:

• Bachelor's degree in business, finance, healthcare, or a related major preferred. High school diploma or GED required.

• A minimum of 3 years of experience with Physician Business Services (PBS) or Patient Financial Services (PFS) Accounts Receivable management required.

• A minimum of 2 years of coding and/or audit experience sought.

• Previous experience working in Analyst role or with database management preferred.

• CPC or other coding certifications preferred.

• Epic Proficiency designation or Certification in PB applications preferred.

Physical Demands:

Reaching 10 lbs., Handling 10 lbs., Grasping, Feeling, Talking, Hearing, Repetitive Motions

Req ID : 777

Working Title : Revenue Integrity Analyst

Department : CSRC PB Rev Integrity and CDM

Business Entity : Cedars-Sinai Medical Center

Job Category : Patient Financial Services

Job Specialty : Revenue Integrity

Overtime Status : EXEMPT

Primary Shift : Day

Shift Duration : 8 hour

Base Pay : $38.87 - $60.25

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.