Note: The job is a remote job and is open to candidates in USA. Rush University Medical Center is seeking a Senior Revenue Integrity Regulatory & Systems Analyst to help translate complex healthcare regulations into accurate, compliant, and optimized charge capture across the organization. The role involves leveraging expertise in coding, CDM, auditing, and Epic systems to identify missed revenue opportunities and drive process improvements in a collaborative healthcare environment.
Responsibilities
• Apply advanced understanding of regulations, NCD’s. LCD’s and payor concepts, along with revenue integrity concepts to make new and existing regulations actionable within the CDM, charge capture, data, and technology space
• Serve as a liaison with compliance to promote and optimize accuracy
• Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement
• Proactively assess systems, processes, and audit revenue integrity output for accuracy and implements process improvement initiatives
• Coordinate and apply regulatory knowledge for Epic optimization and Epic WQ and Charge Router automation recommendations
• Monitor Epic Revenue Integrity build to ensure alignment with regulations and charging rules
• Harness the Epic and industry best-practices promote accurate automation to reduce manual labor
• Use logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines and then propose automation, when applicable
• Analyze revenue integrity denial trends and then provide actionable preventative measures for the Epic build
• Manipulate data along with identifying and translating trends into actionable remedies
• Responsible for accounts within the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner
• Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing
• Audit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits
• Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts
• Identify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges
• Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts
• Meets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager
• Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement
• Engages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned
Skills
• Associates degree or higher with a minimum 5+ years of healthcare experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of healthcare experience working with billing, charge entry, charge capture, or CDM
• AAPC or AHIMA certification
• Epic HB Certification within 6 months
• Proficient and functional knowledge of reviewing charges in the Epic EHR
• Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 Revenue Codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiers
• Excellent written and oral communication skills along with problem-solving
• Proficiency with MS Office Suite
• High degree of accuracy and ability to collaborate with others
• Epic Hospital Billing (HB) certification
Company Overview
• Rush University Medical Center offers healthcare services for children and adults, clinical trials, medical education and training services. It was founded in 1837, and is headquartered in Chicago, Illinois, USA, with a workforce of 10001+ employees. Its website is https://www.rush.edu/.
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