Sr. Revenue Integrity Analyst (CCS/CPC/CCA/RHIT) - On-site position Job at WMCHealth, Valhalla, NY

OFVoc01JNjNKRlJQRGNGeC93RzRGeWw2cGc9PQ==
  • WMCHealth
  • Valhalla, NY

Job Description

Job Summary : The on-site Sr. Revenue Integrity Analyst reviews and revises accounts to achieve revenue enhancement and compliance. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing. The incumbent establishes and maintains a library of rule, regulations, policies and procedures of all governmental and commercial payors.

Responsibilities:

  • Assist various departments in ensuring all denials are captured appealed in a timely manner. Coordinating appeal discussions with clinical third party payors.
  • Develop, Implement and coordinate billing practices between hospital and physician groups to ensure uniform coding and documentation.
  • Recommend sound financial best practices that are able to withstand audits.
  • Foster continuous improvement of revenue cycle processes through education with various departments.
  • Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered.
  • Analyze and maintain WMCHealth Network Hospitals CDMs to maximize revenue.
  • Performs periodic review of codes and works with patient billing regarding bundling and unbundling services as delineated in CMS and CCI edits.
  • Coordinates and serves as liaison with CDM software companies to evaluate and validate CPT and revenue codes and related coverage issues.
  • Engage with various departments to identify opportunities during EMR implementation and provided feedback and recommendations.
  • Serves as the finance liaison with ancillary departments regarding CDM service and procedure changes and educates departments regarding the impact of CDM regulatory changes.
  • Researches technical guidance in UB-92 Editor, CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance.
  • Maintains and provides information on status of audits and issues presented.
  • Participates in quantifying audit outcomes, including revenue realized
  • Researches and communicates appropriate treatment of charges to clinical managers, CDM Specialist (coordinator), other customers.
  • Participates in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
  • Performs other duties as assigned.

Qualifications/Requirements:

Experience: Minimum 8 plus years clinical experience in a hospital setting, preferably cardiology, radiology, surgery or utilization review , required. Previous revenue integrity experience, Excel and Electronic Medical Records experience preferred.

Education : Graduate of an accredited program (RN,MD,PA), degree in healthcare preferred. Bachelors degree or equivalent work experience (8 plus years) required.

Licenses / Certifications: Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H), preferred.

Other: Familiarity with medical record documentation standards and practices, health care insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and ICD-9-CM codes is preferred.

Special Requirements: Requires travel to other WMCHealth Facilities.

Job Tags

Work experience placement,

Similar Jobs

Constellation Energy

Engineer, Sr Fuels Engineer - Nuclear Fuels Special Projects Job at Constellation Energy

 ...vision benefits, including a robust wellness program; paid time off for vacation, holidays, and sick days; and much more. ***This Engineering role can be filled at a Senior Engineer level. Please see minimum qualifications list below for each level*** Expected salary... 

Eide Bailly

Outsourced Accounting Senior Manager (Nonprofit) Job at Eide Bailly

 ...Denver CO, Salt Lake City UT, Bismarck ND, or Las Vegas NV.Work Arrangement: In-office OR HybridA Day in the LifeAn Outsourced Accounting Senior Manager will mentor and oversee the ongoing financial reporting operations of outsourced clients, serving as their Chief... 

Saint Luke's Hospital of Kansas City

Registered Nurse - Medical ICU Job at Saint Luke's Hospital of Kansas City

 ...Saint Luke's North Hospital is looking for a Registered Nurse to join the dynamic Medical Intensive Care Unit. Position...  ...Experience: 1 year Basic Life Support RQI - Resuscitation Quality Improvement (RQI), Registered Nurse (MO) - National Council of State Boards... 

VSolvit

GIS ANALYST II Job at VSolvit

 ...degree in computer science, programming, information systems, or a related field (or actively pursuing a degree) Experience with Esri / ArcGIS software (Desktop and Server technologies) Strong knowledge of ArcGIS for Server software including installation, configuration... 

Boston Children's Hospital

Music Therapist (Emergency Department) Job at Boston Children's Hospital

 ...Position Summary/ Department Summary: Emergency Department Music Therapist 4, 10.5 hour days or 5, 8.5 hour days. The shift will typically start around 10:00 a.m. Key Responsibilities: Provide music therapy to support the developmental, rehabilitative, psychological...