Revenue Integrity Analyst II


MaineHealth


Posted Under: Portland, Maine jobs in Professions; Professions jobs in zipcode 4101
Posted On: 2020-07-01 00:00:00

Summary Position Summary This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the Maine Health organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. Under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst II plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. Required Minimum Knowledge, Skills, and Abilities (KSAs) Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and three (3) to five (5) years' of experience within the revenue cycle. Experience above minimum requirement will be considered in lieu of education. License/Certifications: Applicable professional certification through AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC) or Pharmacy Technician (CPhT, PTCB). Experience: Three (3) to five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. EPIC HB/PB experience preferred. Proficiencies: Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations. Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical -thinking and the ability to meet deadlines while influencing, but not directly managing the work of others. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.