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

cUdKRC84SkdOWG5vd0d5Qkx5VmVSRGNRY0E9PQ==
  • 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 CDM's 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. Bachelor's 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.

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

  • Health Insurance
  • Dental
  • Vision
  • Retirement Savings Plan
  • Flexible Savings Account
  • Paid Time Off
  • Holidays
  • Tuition Reimbursement

Job Tags

Holiday work, Work experience placement, Flexible hours,

Similar Jobs

Cheese Bus Inc

School Bus Driver Job at Cheese Bus Inc

 ...Career Advancement Opportunities Flexible Schedule Job Summary We are seeking an experienced and safety-conscious School Bus Driver to join our team! As the School Bus Driver, you will be responsible for the safe operation of the school bus while adhering to... 

Global, a 1st Flagship Company

Marine Insulator Job at Global, a 1st Flagship Company

 ...California, and Hawaii. \n We are currently seeking skilled Marine Insulators for a potential 5-year project in Norfolk, VA. This...  ...and shipboard structures. \n Responsibilities : \n \n Install thermal, sound, and protective insulation materials. \n Shape... 

Robolink

Junior Product & Visual Designer Job at Robolink

Job Title: Junior Product & Visual DesignerDepartment: ProductLocation: Onsite Chicago, ILType...  ...Summary:As a Junior Product & Visual Designer, youll play a key role in shaping how...  ...designs that can be handed off to Software and Web teams for implementation and... 

COMPA Industries, Inc.

Electrical Safety Officer - SME Job at COMPA Industries, Inc.

 ...Job Description Senior Electrical Safety Officer (Subject Matter Expert 1 or 2) Client: Los Alamos National Laboratory (LANL) Location: Los Alamos, New Mexico Citizenship: U.S. Citizenship Required Clearance: Must be able to obtain and maintain a DOE... 

Healthcare Support

Travel Nurse RN - Skilled Nursing Facility (SNF) Dialysis Job at Healthcare Support

 ...Job Description Healthcare Support is seeking a travel nurse RN Skilled Nursing Facility (SNF) Dialysis for a travel nursing job in Washington, Pennsylvania. Job Description & Requirements ~ Specialty: Dialysis ~ Discipline: RN ~ Start Date: 12/15/2025~...