REVENUE INTEGRITY ANALYST

Job ID: J131217
Company: West Penn Allegheny Health System
Location: Pittsburgh, PA, United States
Facility: 4 Allegheny Center
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 5, 2018

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Description

GENERAL OVERVIEW:

Performs reporting and analysis of the revenue cycle for monitoring and problem resolution; assists staff with internal and external system issues and questions relative to accounts receivable; acts a primary liaison with other parties to resolve system issues and ensure compliance with all regulations; participates in department/system initiatives involving testing and other activities to ensure overall goals are met. Performs other duties as assigned.

ESSENTIAL RESPONSIBILITIES:

  • Activities related to Revenue Integrity coding modifiers, charging guidelines, and billing edits to maximize reimbursement for services. (20%)
  • Reviews, analyzes and resolves accounts that have failed coding and charging related claim edits, National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), Medically Unnecessary Edits (MUE), and other exceptions requiring clinical/coding expertise, with oversight. (10%)
  • Works closely with Revenue Cycle teams to resolve rejections and denials. (10%)
  • Analyzes accounts flagged for potential missing charges; interacts with clinical departments to obtain additional information needed to property bill accounts based on clinical documentation. (10%)
  • Compile information and/or prepare reports and analyses setting forth results of reviews with appropriate recommendations and conclusions.(10%)
  • Analyzes billing error and denials data to resolve accounts and identify root causes. (20%)
  • Reviews, researches and documents trends with a focus on identifying charging and documentation opportunities. (20%)

QUALIFICATIONS:

Minimum

  • High School/GED
  • 1-3 years hospital or physician revenue cycle, billing, coding or billing experience

Preferred

  • Associate’s Degree
  • Basic understanding of CPT/HCPCS and diagnosis coding, and provider billing operations
  • Knowledge of various software applications, Microsoft Office, Word, Excel and various billing software
  • Experience with electronic health records (EPIC)

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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