Charge Integrity Analyst - Revenue Integrity Remote

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REMOTE REQUIREMENT

Must be a resident of Texas, Louisiana, Mississippi, Alabama, Florida or Georgia

GENERAL DUTIES:

• Collaborate with Charge review Coordinators and Charge Review Specialist to monitor charge capture functions across all LCMC entities.
• Conducts thorough reviews of patient charges to ensure services provided are accurately captured and billed.
• Verify the correct usage of procedure codes (CPT/HCPCS) and diagnosis codes (ICD-10) to ensure charges align with clinical documentation.
• Identify and investigate charge discrepancies, missing charges, or incorrect coding, and work with relevant departments to resolve issues.
• Serve as a resource for charge integrity specialists and departments on charge-related inquiries, providing support and guidance on proper charge capture practices.
• Provide feedback and training to clinical departments on charge capture issues and regulatory changes that impact billing and coding with oversite by the charge review coordinator.
• Educate on best practices for documentation and charge entry to enhance revenue capture and compliance.
• Prepare and present reports on charge review findings, highlighting areas of improvement and compliance risks.
• Monitor key performance indicators (KPIs) related to charge capture accuracy and timeliness. Create action plans when KPI’s are above target.
• Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
• Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
• Monitors EPIC Revenue Integrity Dashboard(s) and Ri assigned work queues to assist in completion and timeliness of completion meeting Revenue Integrity Department standards.
• Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity. 
• Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, charge capture navigators, and other charge components. 
• Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
• Train and assist in daily resolution of revenue integrity edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation.
• Performs miscellaneous duties as assigned.
• Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
• Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders. 
• Excellent organizational and project management skills. 
• Strong time management, attention to detail, and follow through. 
• Well-developed research skills. 
• Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
• Work effectively as a team contributor on all assignments.
• Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
• Delivers positive patient experience, where applicable.

EXPERIENCE QUALIFICATIONS:

• Minimum: 3 years' experience in the hospital setting, healthcare industry, revenue cycle or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management.
• Preferred:  EPIC HB/PB experience

EDUCATION QUALIFICATIONS:

• Minimum: High school diploma or GED with equivalent combination of certification and experience is required.
• Preferred: Associate’s degree in healthcare administration, Health Information or related field is preferred.

LICENSES AND CERTIFICATIONS:

• Applicable professional certification through AHIMA (RHIA, RHIT, CCS), RN, LPN or AAPC (COC, CPC) or Epic Certified

SKILLS AND ABILITIES:

• Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500.
• Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10.
• Advanced knowledge of NCCI edits, and Medicare LCD/NCDs.
• Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care.
•  Ability to review, analyze and interpret managed care contracts, billing guidel