Revenue Integrity Analyst II - Physician Integrity

  • MaineHealth
  • Biddeford, ME 04005, USA
  • Jan 07, 2021

Job Description


**Remote work available within a per diem schedule**
  • Position Summary
    • Under the direction of the Director of Physician Svs Revenue Integrity, this position is responsible for evaluating processes and identifying opportunities to improve the revenue/charge capture processes and workflows for Southern Maine Health Care Physician practices; , using a LEAN process innovation approach and techniques such as A3s and root cause analysis. The Physician Svs Revenue Integrity Analyst II identifies potential compliance issues both pre-and post-claim submission; identifies charge capture opportunities and works collaboratively with SMHP EPIC Ambulatory Support team, SMHC Physician Coding dept. and others to ensure timely and accurate charge capture and claim submission. The Revenue Integrity Analysts also to assist in meeting Revenue Cycle's goal of increasing percentage of net AR collected within a 120 day timeframe. A key responsibility is working closely with physician practice departments to drive process changes to assure revenue and compliance integrity. The Revenue Integrity Analyst II will also be investigating, tracking and appealing technical claim denials. This position contributes to the reinforcement of the mission of the Revenue Integrity Program in building a partnership between finance and the clinical departments in order to gain greater visibility into business processes and develop the workflows, communication, accountability and leadership needed to ensure optimal reimbursement and compliance.
  • Required Minimum Knowledge, Skills, and Abilities (KSAs)
    • Education: A Bachelor's Degree, preferably in Healthcare Administration, Business, Finance, or computer programming and (3) years' experience within the revenue cycle. Experience above and beyond minimum requirement will be consisted in lieu of education.
    • License/Certifications: Strongly preferred certification as a medical coder through AHIMA (CCA, CCS, CCS P) or through AAPC (CPC A, CPC, COC, CIC) and/or preferred certification as a Pharmacy Technician CPhT. Or Certification as Revenue Cycle Integrity Professional. On certification needed within 1 year of date of hire.
    • Experience: Knowledge of revenue cycle processes, medical billing (preferably three (3) years’ experience) and coding processes, CPT, HCPCS, ICD 9/10, NCCI edits, Medicare LCD/NCD, basic accounting principles, quantitative decision making and process analysis through formal education or two years of work experience in the revenue cycle. Meditech experience preferred.
    • Advanced level of communication, interpersonal, problem solving and organization skills in order to maintain a high level of production and accuracy in an extremely task driven environment.
    • Proficiencies: Advanced computer analytical skills to create and maintain reports and provide analysis (1) in support of project initiatives and (2) to resolve complex charging/revenue issues (Microsoft Excel, Word, Outlook, etc.). Ability to utilize LEAN process innovation techniques for root cause analysis.