Rid Analyst - Revenue Integrity - FT 1.0 (80 hrs biweekly) (63615)

In an environment of continuous quality improvement, the RID Analyst is responsible for performing detailed analysis of organizational charges, medical documentation, itemized bills, nursing procedures, and department documented charges. The RID Analyst is also responsible for preparing educational materials and delivering education to necessary departments as identified during audits. The RID Analyst will also utilize varying software tools to identify targets of focused audits for charge capture analysis. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.

Job Functions:

1. Performs shadowing and coaching with key stakeholders in the departments to facilitate adoption of best practices and improve documentation and charging accuracy.
2. Performs review of accounts identified as potentially missing charges and conducts additional research to help resolve areas of opportunity and identify the root cause of the issues causing the missed charges.
3. Develops and maintains project plans and project tracking, including documentation of project meetings and project issues lists.
4. Performs revenue optimization functions including review of accounts for potential missing documentation, coding and charging; identify root causes of missing charges; education clinical and ancillary departments; perform process improvement activities aimed at revenue optimization; coordinate with clinical departments, coding, CDM, and other key stakeholders to address and resolve root cause issues.
5. Auditing and monitoring of defined areas.
6. Use of appropriate systems and resources for coding and charge capture (ie Craneware, Charge Connect, etc)
7. Identifies and reports issue trends to leadership with solution options
8. Assumes all other duties and responsibilities as necessary.

Minimum Education/Experience Required:

• Associates Degree in healthcare-related field required or in lieu of education, a minimum of four years relevant experience required.
• Bachelor’s degree preferred.
• Licensure/Certification: RN, LPN, or RHIA, RHIT, CPC, COC, CDEO, CCS required.
• Previous auditing experience preferred.

Special Knowledge, Skills, Training:

• Computer skills (word processing, spreadsheet, graphics, and database software applications).
• Strong quantitative, analytical, and organization skills.
• Proficient in chart.
• Review, clinical record information systems, and coding methodologies.
• Ability to understand and interpret medical records, hospital bills, and the charge master.
• Ability to understand all ancillary department functions.
• Ability to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies.
• Ability to effectively negotiate with insurance carrier representatives and customers.
• Ability to communicate orally and in written form.
• Ability to utilize and understand computer technology.
• Must be team-oriented with strong interpersonal skills. 
• Effective verbal and written communication skills and good listening skills. 
• Ability to interpret end user’s needs.    

Compensation Details:  Education, experience, and tenure may be considered along with internal equity when job offers are extended.<