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

Stantec

Senior Technology Consultant Job at Stantec

 ...see infrastructure not just as systems, but as opportunities to serve people and protect the environment. Our Management & Technology Consulting (MTC) team helps utilities and public agencies solve complex challenges at the intersection of data, technology, and operations... 

Knight Federal Solutions Inc

Graphics Developer/Designer (Web Dev/Des - OPAMS) Job at Knight Federal Solutions Inc

 ...assessments by developing graphic and layout solutions. Provides graphic design and layout solutions for intelligence products including, but...  ...technology to produce or modify USCENTCOM J2 organization web, SharePoint pages, and templates; other graphic user interface (... 

Care Options for Kids Careers

New Graduate Pediatric Nurse RN/LPN Job at Care Options for Kids Careers

 ...Requirements for Licensed Practical Nurses (LPNs)* Valid Pennsylvania LPN License or Multistate License * TB Skin Test (PPD) or TB Blood...  ...for Kids Care Options for Kids is the leading provider of pediatric nursing services. Our mission is to provide high-quality... 

Honor

Caregiver (No Experience Required) Job at Honor

 ...Caregiver / Home Care Aide $18.50$19.25/hr | Weekly Pay & Benefits Join Honor as a professional Caregiver and earn weekly pay while helping seniors stay safe and independent at home. We offer clear pay, reliable hours, and the benefits you deserve. What you... 

Bath Concepts Independent Dealers

Call Center Manager Job at Bath Concepts Independent Dealers

 ...Job Description Job Description Call Center Manager | New Bay Remodeling Location: Clearwater, FL Full-Time About Us: At New Bay Remodeling , were transforming the bath remodeling industry with fresh, stylish, and low-maintenance solutions for homeowners...