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Revenue Integrity Analyst in Columbia, SC at Providence Health

Date Posted: 12/29/2018

Job Snapshot

Job Description

Providence Health

Founded as Providence Hospitals in 1938 by the Sisters of Charity of St. Augustine, Providence's two free standing full-service hospitals and numerous satellite practices maintain a true devotion to advanced clinical expertise and unmatched compassion. On February 2, 2016, Providence became part of the LifePoint Health network, and shortly thereafter, changed its name to Providence Health to better represent the full complement of its services. Driven by quality, compassion, and Christ, Providence treats the whole person- body, mind, and spirit.
Providence Health is in search of a skilled and experienced Revenue Integrity Analyst to join our team.
Revenue Integrity Analyst Position Summary: The Revenue Integrity Analyst is responsible for performing medical and revenue audits to ensure revenue integrity as related to adherence with local, federal and state compliance guidelines, policies of external payers, coding rules and guidelines. In addition, to managed care reimbursement practices in order to improve the accuracy and efficiency of the charge capture phase of the revenue cycle.
Job Functions:
  • Uses clinical knowledge and billing experience to compare the Electronic Health Record (EHR) documentation to patient account charge detail and individual items billed
  • Works with Identified Departmental Clinical Liaisons to routinely identify compliant charging opportunities, proactively identifying revenue opportunity and suggests improvements with revenue cycle leadership to prioritize audits as it relates to charge capture and/or revenue flow.
  • Assists the Identified Departmental Revenue Integrity Clinical Liaisons in identifying and communicating missing or misdirected charges to individual clinical/ancillary departments.
  • Works closely with Health Information Management (HIM), Clinical Documentation Improvement (CDI), Revenue Cycle, Finance and Patient Financial Services (PFS) departments to resolve charge capture related issues
  • Responsible for conducting quality control audits to ensure data/ documentation integrity.
  • Communicates audit findings and recommendations, explaining regulatory requirements and overseeing the corrective actions for audits within operational units.
  • Serves as a Subject Matter Expert (SME) to hospital leadership on issues related to Revenue Integrity.
  • Compiles information and /or prepare reports and analyses setting forth data integrity findings with appropriate recommendations.
  • Performs subsequent audits to ensure complete and corrective actions have been implemented and/or followed.
  • Follows up with identified health team members to ensure accurate and complete documentation in the EHR.
  • Works collaboratively with identified operational leaders to develop provider education strategies to promote complete, accurate and compliant clinical documentation.
  • Utilizes knowledge based discovery to correct negative trends and identify process improvement, including education, operational workflow modifications systems enhancements and works with identified personnel to implement these improvements.
  • Review payments for accuracy from contracted payers and management of appeal process with assigned audits.
  • Audits and enters defined patient care charges at or above minimum accuracy and productivity rate set by department leadership (accuracy measured by monthly quality reviews).
  • Monitors reports of defined patient type accounts via charge capture audit system on a routine basis, keeping number of accounts below goals set by department leadership.
  • Works effectively with revenue cycle department to thoroughly understand how clinical changes impact changes net revenue.
  • Performs wide range of duties in support of total department efficiency including but not limited to the involvement in aspects of developing the annual pricing update; creating, updating and maintaining the charge description master (CDM) with minimal errors as established by Revenue Integrity Leadership.
  • Utilizes established coding and charging guidelines for accurate data capture and reimbursement.
  • Knowledge based regarding edits and criteria for corrective action on billing errors, confirms edits are completed timely to insure proper charge capture.
  • Adheres to Providence Hospital Compliance Plan, rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
  • Fulfills other assigned responsibilities, duties and tasks of them not specifically listed within this job description and as directed by employee’s Director or Administrative representative.

Job Requirements

Minimum Education
Bachelor degree preferred. One year student coder and/or certificate graduate required. In some situations experience may be considered in lieu of education.
Minimum Work Experience
Four years healthcare experience in audit or coding is required, clinical experience preferred.
Required Skills
  • Required to complete LifePoint Coding and Revenue Integrity compliance training. Continuing education will be provided by LifePoint Coding and Revenue Integrity Program, CEU’s will be maintained and reported annually to LifePoint
  • Demonstrated customer service skills, excellent written and oral communication. Strong independent decision making, utilizing analytical and problem solving skills.
  • Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience is preferred, proof of certification expected within one (1) year of hire.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran


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