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REVENUE INTEGRITY ANALYST - FINANCE
Costa Mesa, CA The Revenue Integrity Analyst is a technical expert relative to the Hospital's Charge Description Master (CDM), with particular emphasis on hospital charge capture, compliance, strategic pricing, and revenue protection. Under general supervision, the Revenue Integrity Analyst will develop, maintain and report on the Hospital CDM in order to optimize revenue generation, and maintain compliance with 3rd party payer requirements. This position provides training for departmental personnel relative to charge capture as well as supports clinical areas in the development of pricing for services and supplies in consideration of cost and market. Essential Functions · Serves as the principal point of contact for charging related issues. · Responsible for managing, coordinating, and implementing all edits to the chargemaster. · Works closely with clinical departments to educate in charge capture and pricing. · Implements annual price increase and coordinates Medicare OPPS updates. · Makes recommendations relative to compliance concerns related to charging practices. · Analyzes and resolves specific billing edits/errors that are delaying claims for processing in EPIC. · Ensures revenue routes to the correct cost center, audits for missing charges and late charges. · Reports and tracks Epic charge-related issues for resolution. · Coordinates to Finance team any productivity (RVU) revisions as impacted by CDM changes. · Creates policies and procedures related to hospital charge practices. · Perform other duties as assigned. Education, Training and Experience Required: 3-5 years' experience in a healthcare environment with emphasis on chargemaster and revenue capture. Preferred: Bachelor's degree preferred, in business administration, finance, accounting, or healthcare administration Skills or Other Qualifications Required: Applicant has a general understanding of outpatient Medicare reimbursement methodologies, including CPT/HCPC and UB Revenue Coding. General knowledge of healthcare Revenue Cycle operations. Computer technical skills with Microsoft Office Excel. EPIC knowledge a plus. Proven excellent communication and customer service skills, including the ability to progressively investigate, analyze and identify sources of problems, provide practical solutions, and resolutions. Ability to make independent business decisions, considering both the impact to client satisfaction and overall financial impact for the department and organization. Ability to streamline processes for efficiency. Strong analytical aptitude and experience creating financial analysis. Possesses good sense of general business acumen |
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