Revenue Integrity Analyst – Patient Accounting *Remote Position*

Location: Healdsburg, CA (Remote Position)

Work Schedule: Full Time – 80 Biweekly Hours

Shift: 8-hour, Days

Job Summary

The Local Revenue Integrity Analysts is responsible for charge reconciliation and analysis of financial data as it relates to regulatory compliant charging and billing guidelines. Under general supervision this regional position supports the entire revenue cycle by using clinical expertise and analytical skills to resolve charging and billing issues.

Essential Functions

• General Accountabilities:
• Demonstrates Providence St. Joseph Health System core values of dignity, justice, excellence, and integrity to customers, employees, and visitors; and provides quality service in the performance of work assignments and duties.
• Maintains confidentiality of all information related to patients, medical staff, employees, and as appropriate, other information.
• Demonstrates service excellence and positive interpersonal relations in dealing with others.
• Responsible to maintain a working knowledge of the culture and different practices/services as a Multi-Facility department and organization.
• Responds timely and accurately to all requests received.
• Revenue Accuracy:
• Independently reviews and analyzes complex daily reports that relate to revenue accuracy.
• Uses clinical, audit and analytical skills to independently conduct reviews of medical record documentation compared to patient charges on a concurrent and/or retrospective basis.
• Works closely with charge producing departments and IS and takes initiative in investigating and resolving billing and charging issues.
• Provides education to clinical departments on charge accuracy and charge compliance.
• Trains departments on charge entry and reconciliation processes in order to comply with PSJH standards.
• Revenue Integrity:
• Responsible for managing daily revenue as related to charging.
• Serves as a primary revenue integrity resource and liaison for charge producing departments, Revenue Cycle management, HIM-Coding, Case Management and Admitting, and RICDM.
• Independently addresses patient, department and administrative requests for a variety of issues related to revenue and charge integrity.
• Performs analysis on suspected issues to determine root cause and provide corrective action plan.
• Ensure assigned work queues are completed per policy and support department with their assigned work queues for timely resolution.
• Maintains a detailed and comprehensive roster on the shared drive, of contacts and names/numbers for charging departments.
• Provide training and support to departments in analyzing and resolving issues related to charge capture.
• Revenue Compliance:
• Interprets and resolves government billing edits (NCCI, MUE’s, Coding Pairs, LCD, NCD).
• Responsible for making recommendations to ensure billing compliance regulations and PSJH standards are adhered to as it relates to charging.
• Maintains expertise in multiple data sources to extrapolate information needed for analyzing and auditing clinical and financial records. Identifies and recommends improvements/adjustments to the Local Revenue Integrity Manager.
• Assists in charging audits, internal charging audit, and external charging audits.
• Manages change requests through IS ticketing system and provide appropriate documentation for all requests.

Skills

• Extensive familiarity with CPT and HCPCs coding requirements, including Medicare and Medi-Cal regulations, NCCI edits, etc.
• Extensive clinical knowledge of hospital services, pharmaceuticals, medical records documentation, etc.
• Extensive knowledge of the dynamics of charge accuracy programs.
• Strong computer skills including working knowledge of Excel and Word. Ability to use internet search capabilities, online reference sites. Ability to adapt quickly to new systems and tools.
• Strong knowledge of hospital and free standing imaging billing requirements, billing systems, payer contract parameters, proration protocols, etc.

Minimum Position Requirements

Experience: 1 year Experience in the healthcare industry (business office, finance, revenue audit, coding). 3 years preferred.

Preferred Position Qualifications

Education: Bachelor’s Degree in Healthcare or Finance.

Experience

• Coding certification or experience.
• Experience with Epic charge capture and work queue management.

Licenses/Certifications

• Coding certification.
• Clinical Certification (RN, LVN).

Providence St. Joseph Health (Providence) has worked for decades to improve health and quality of life in California’s North Bay region, starting in Sonoma County, where the Sisters of St. Joseph of Orange opened the doors of Santa Rosa Memorial Hospital in 1950. Today, we continue the mission begun by the Sisters to those we serve through an integrated spectrum of primary, urgent, acute, outpatient, palliative care and regional referral services. Sonoma County facilities aligned with Providence include the 278-bed Santa Rosa Memorial Hospital, the region’s only Level II trauma center. In addition, the 80-bed Petaluma Valley Hospital and 43-bed Healdsburg Hospital are secular (non-religious) affiliates of Providence. Our services also encompass three Urgent Care centers, Hospice of Petaluma, Memorial Hospice and North County Hospice, the Annadel Medical Group doing business as St. Joseph Health Medical Group, as well as the St. Joseph Home Care Network (post-acute care services). We act as a regional referral hub for outlying hospitals, while also providing outpatient behavioral health care, education to promote health and prevent chronic disease, rehabilitation, oral health care, community benefit programs, and more, all fostering health and quality of life throughout the area.

Providence provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Providence complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Positions specified as “on call/per diem” refers to employment consisting of shifts scheduled on as “as needed basis” to fill in for staff vacancies.