Revenue Integrity Analyst II

Vail Health has become the world’s most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital.  This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here.

Some roles may be based outside of our Colorado office (remote-only positions). Roles based outside of our primary office can sit in any of the following states: AZ, CO, CT, DC, FL, GA, ID, IL, KS, MA, MD, MI, MN, NC, NJ, OH, OR, PA, SC, TN, TX, UT, VA, WA, and WI. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.   About the opportunity:

The Revenue Integrity Analyst II performs all duties of a level one as well as assists with the revenue cycle functions of clinical departments throughout the organization. This position develops, implements and maintains the integrity of the charge description master (CDM) through effective management of the facility and professional charge related dictionaries to ensure compliance with Federal, State, Local and internal policy requirements.

What you will do:

1. Supports clinical departments in Revenue Cycle functions including, charging, reporting, edits and denials, charge reconciliation, compliance/regulatory updates, volumes/stats.
2. Works collaboratively with clinical departments and facilities to develop charges for new and revised procedures/programs which are compliant with regulatory requirements and internal policies.
3. Assists in the evaluation of current charging, coding and auditing processes in clinical areas and make recommendations to insure optimal and accurate charge capture and provide education, feedback and documentation to clinical area on identified issues to support correct charging and coding at the point of charge entry.
4. Demonstrates good understanding of federal, state and third-party charging guidelines to identify required changes to the CDM and provide guidance and education to departments on appropriate charging and coding practices.
5. Assists departments, including Patient Financial Service and Health Information Management, clinical departments, in resolving issues, edits, charging/billing errors or denials related to the charge master in accordance with regulatory guidelines and research issues, provide options and make recommendations to resolve identified issues.
6. Prepares reports on non-compliance or error trends and works with the departments to facilitate compliance, ensure appropriate revenue capture, and/or reduce Accounts Receivable (AR) through appropriate and efficient process flow.
7. Reviews current pricing as compared to Ambulatory Payment Classification (APC), Physician Fee Schedule (PFS) and market data. Provide back-up support to Patient Financial Services to provide procedure cost estimates in response to patient inquiries.
8. Quantifies and provides comparative data to understand impact of how changes to the charges will financially impact the department or facility.
9. Provide CDM/charge-related data/reports for decision-making support, as requested and within scope.
10. Role models the principles of a Just Culture and Organizational Values.
11. Perform other duties as assigned. Must be HIPAA compliant.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.   What you will need:   Experience:

• 3 years of related revenue cycle experience required.
• 1 year Cancer Center Revenue Cycle experience required.
• CDM Experience in an acute care organization required.
• ICD/DRG and/or CPT/APC coding and reimbursement concepts knowledge required.
• Facility and/or professional coding and billing knowledge required.
• Knowledge of patient billing systems, health procedures and classification systems required.
• Knowledge of hospital accounting systems and practices as related to patient billing required.
• Proficiency in medical terminology, hospital charge masters, charge review, clinical record information systems, and coding methodologies required.
• Experience in a start-up environment preferred.
• Experience in implementing patient billing and accounting systems preferred.
• Experience with Cerner and Mosaiq preferred.

License(s):

• N/A

Certification(s):

• Radiation Oncology Certified Code