The Revenue Integrity Professional Analyst is responsible for evaluation, assessment and education to Shriners Hospitals for Children (SHC) providers as a component of conducting audit processes and ensuring adherence to SHC revenue cycle policy. The Analyst is responsible for the development and adherence to processes and procedures to assure timely and appropriate capture of all chargeable activities throughout SHC, as well as the development of a means to facilitate collaboration and standardization across all professional care within SHC in support of charge capture. The Analyst will ensure accurate and timely auditing of revenue cycle chargeable services and activities throughout SHC and will utilize skills to professionally communicate and facilitate the collaboration and standardization of charge capture processes for all professional services within SHC in support of revenue integrity.
Shriners Hospitals for Children is an EOE/Drug-Free, Smoke-Free Workplace
- Conducts revenue integrity audit activities for compliance related to internal policy, CMS, Medicaid and managed care regulations and requirements, communication, outcomes analysis and reporting for the purpose of internal quality control.
- Provides analysis, trended reports and well supported documentation for audit findings, recommendations and/or corrections to individual provider processes according to best practice, compliance and SHC policy.
- Assists in identifying, defining and functioning within SHC proprietary software processes; review and/or development of reports and audit tools to support the requirements for revenue integrity and outcomes measurement.
- Participates in the implementation and audit processes to ensure that charges are recognized appropriately and uniformly to all professional patient services at a physical location, regardless of payer. Performs all audits with a focus on revenue cycle integrity.
- Assists with review and assessment of payer correspondence to identify bill problem resolution. Uses experience and knowledge to communicate, coordinate and/or forward correspondence according to established areas of responsibility.
- Provides coverage guidelines for billable services to reduce or prevent future compliance challenges. Remains current on all government and third party billing compliance.
- Conducts charge capture assessment activities including, interviews and research along with outcomes analysis. Provides analysis, well supported documentation and recommendation for changes, additions and/or corrections to the CDM according to best practice and company standards.
- Assists in defining and assures compliance with the requirements for standardize charge capture workflows. Assists with the monitoring of the SHC Corporate system – wide CDM to ensure that the coding of new and existing charge codes is within applicable coding and billing guidelines.
- Participates in the implementation and audit processes to ensure that charges are applied uniformly to all patient services at a physical location, regardless of payer. Performs audits with a focus on revenue cycle integrity, assist in the development and implementation of charge practices.
- Assists with bill problem resolution based, and provides coverage guidelines for billable services to reduce or prevent future claim denials. Ensures the appropriate bundling or unbundling of charges so that all submitted charges result in maximum reimbursement while following applicable billing, coding and reimbursement regulations. Remains current on all third party billing compliance.
- Provides support, communication and education to multiple providers and corporate staff on correct charge capture, billing and coding processes, and state and federal guidelines.
- Assesses the accuracy of charge forms, charge screens, charge stickers and other charging vehicles. Works as part of the team to review and analyze unique site-specific procedures that need to be billed and developed on charge forms as applicable.
- Provides support, communication and education (telephonically, electronically and in person), to multiple facilities and corporate staff on correct charge capture, billing, process documentation, and state and federal guidelines.
- Completes special projects as directed by the Corporate Director of Revenue Integrity/ Denials Management/Professional Coding and/or Corporate Controller.
- Effectively and professionally communicates results, challenges and solutions through daily interaction, regular reports and monthly status meetings with Corporate Director of Revenue Integrity/Denials Management and/or Corporate Controller.
- Plans and organizes the functions and activities of area of responsibility to ensure department and corporate goals are met.
- Provides other support as needed and assigned by Corporate Director of Revenue Integrity/Denials Management.