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Sr Revenue Integrity Analyst

Company: Westchester Medical Center
Location: Valhalla
Posted on: April 8, 2021

Job Description:

Company: NorthEast Provider Solutions Inc. Department: Denials Mgmt-WMC Health Position: Full Time Hours: M-F 8:30-5pm Shift: Day Job Summary: The Sr. Revenue Integrity Analyst reviews and revises accounts toachieve revenue enhancement and compliance.This position updates and reviews accounts to ensure accurate andcomplete charge capture and accurate, timely billing. The incumbent establishes and maintains alibrary of rule, regulations, policies and procedures of all governmental andcommercial payors. Responsibilities: Assist various departments in ensuring alldenials are captured & appealed in a timely manner. Coordinating appeal discussions with clinical& third party payors.Develop, Implement and coordinate billingpractices between hospital and physician groups to ensure uniform coding anddocumentation.Recommend sound financial best practices thatare able to withstand audits.Foster continuous improvement of revenuecycle processes through education with various departments.Identify pre-bill and post-bill claim editsinvolving any type of clinical or coding review or required modifier based onservices rendered.Analyze and maintain WMCHealth NetworkHospitals CDM's to maximize revenue. Performs periodic review of codes and workswith patient billing regarding bundling and unbundling services as delineatedin CMS and CCI edits.Coordinates and serves as liaison with CDMsoftware companies to evaluate and validate CPT and revenue codes and relatedcoverage issues.Engage with various departments to identifyopportunities during EMR implementation and provided feedback andrecommendations.Serves as the finance liaison with ancillarydepartments regarding CDM service and procedure changes and educatesdepartments regarding the impact of CDM regulatory changes. Researches technical guidance in UB-92Editor, CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billingissues and promote regulatory compliance.Maintains and provides information on statusof audits and issues presented.Participates in quantifying audit outcomes,including revenue realizedResearches and communicates appropriatetreatment of charges to clinical managers, CDM Specialist (coordinator), othercustomers.Participates in required regulatory changeimplementations and ongoing monitoring related to compliant charge capture.Performs other duties as assigned.Qualifications/Requirements: Experience: Minimum 5 years' clinical experience in ahospital setting, preferably cardiology, radiology, surgery or utilizationreview, required. Previous revenue integrity experience,Excel and Electronic Medical Records experience preferred. Education: Graduate of an accreditedprogram (RN,MD,PA), degree in healthcare preferred,Bachelor's, required. Licenses / Certifications: Certified Professional Coder (CPC) orCertified Professional Coder-Hospital (CPC-H), preferred. Other: Familiarity with medical record documentation standards andpractices, health care insurance billing issues, and federal and state billingcompliance issues for hospitals; knowledge of CPT-4 codes and ICD-9-CM codes ispreferred.Special Requirements: Requires travel to other WMCHealthFacilities.

Keywords: Westchester Medical Center, Yonkers , Sr Revenue Integrity Analyst, Professions , Valhalla, New York

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