Revenue Integrity Analyst Resume Sample
Trinity Block
11793 Kris Avenue,
Phoenix,
AZ
+1 (555) 695 5541
Work Experience
Regional Revenue Integrity Analyst
12/2016
-
PRESENT
San Francisco, CA
- Working knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues
- Maintains dashboard of financial activity, reviewing and reporting anomalies in a timely fashion. Provide routine reports to the area’s Quality committee and others as requested
- Working knowledge of the principles, practices and tools relating to accounting, financial management, reimbursement, and general healthcare billing
- Understand and effectively complete report creation, audit techniques, spreadsheet presentations
- Convince others and persuade to timely action based on regulations, risk exposure level, compliance deficiencies and audit findings
- Working knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority
- Working knowledge of medical terminology and health care nomenclature, systems, HIM coding and general billing/reimbursement practices
Revenue Integrity Analyst
10/2011
-
07/2016
Dallas, TX
- Convey technical information effectively in verbal and written communications, and in group/business presentations
- Use office equipment and automated systems/applications/software at an acceptable level of proficiency, including Excel
- Hospital, Financial Counseling or Physician Office experience required
- Strong knowledge of medical terminology, CPT codes,
- Expertise in Commercial Insurance/ Medicaid guidelines
- Organizational skills with a focus on time sensitive management
- Assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation
Revenue Integrity, Analyst
03/2009
-
04/2011
Los Angeles, CA
- Coordinate Charge Description Master (CDM) error findings with CDM team
- Reviews patient records and is able to assist with account fixes, charge reconciliation for other departments based on clinical documentation
- Monitor EPIC Revenue Integrity Dashboard(s)
- Responds to departmental charging inquiries timely
- Provide support for assigned cost centers within service lines and in collaboration with your team
- Works with Coding and other clinical departments to identify/fix errors based on ICD/CPT Coding Guidelines and National Correct Coding Initiative edits
- Contributes in support of quarterly improvement initiatives as directed by department director or team leader
- Provides financial modeling resources for special projects assigned to the department by management for analysis. Brings strength in logic and analysis of data, sorts through data and determines which elements are useful or pertinent to the assigned project. Identifies outliers and recognizes trends, presents data and analysis results to appropriate parties
- Assists in identification and implementation of operating improvements and efficiencies by identifying important trends and variances through the review of management reports and financial analysis. Educates users of the assigned financial reporting system on the utilization of reports and the functionality of those reports
Education
University of Phoenix - Nashville Campus
2004 - 2008
Master's Degree in Business
Professional Skills
- Strong interpersonal skills; able to deal effectively with diverse skill sets and personalities
- Strong proven analytical experience demonstrated through managing multiple projects and providing quantitative data analysis
- Experience in a team-oriented role requiring strong interpersonal and communication skills
- Strong written and verbal communication skills including the ability to communicate results of data analysis to a variety of stakeholders
- Excellent critical thinking, analytical skills
- Strong interpersonal, teamwork, organizational and time management skills
- Excellent writing, interpersonal and organizational skills
How to write Revenue Integrity Analyst Resume
Revenue Integrity Analyst role is responsible for database, training, organizational, coding, word, excel, coaching, analytical, web, finance.
To write great resume for revenue integrity analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Revenue Integrity Analyst Resume
The section contact information is important in your revenue integrity analyst resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Revenue Integrity Analyst Resume
The section work experience is an essential part of your revenue integrity analyst resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous revenue integrity analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular revenue integrity analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Revenue Integrity Analyst resume experience can include:
- Working knowledge of database programs and demonstrated ability to run queries using SQL
- Hospital or physician revenue cycle, billing, coding or billing experience
- Two years working experience using word processing and spreadsheet programs
- Experience in a Hospital setting with familiarity of departmental charging
- Experience working in hospital a business office or the healthcare field
- Rrobust experience in excel and reporting
Education on a Revenue Integrity Analyst Resume
Make sure to make education a priority on your revenue integrity analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your revenue integrity analyst experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Revenue Integrity Analyst Resume
When listing skills on your revenue integrity analyst resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical revenue integrity analyst skills:
- Coding and CDM skills
- Strong interpersonal, communication, project management, and process improvement experience using data to make impactful change is required
- Quantitative and financial analysis skills
- Highly organized with proven ability to prioritize workload, meet deadlines, and manage several projects at one time
- Computer skills: navigation and edit resolution through various Web based systems. Ability to use email, Excel, Word
- Exceptional oral/written communication skills and highly customer-focused
List of Typical Experience For a Revenue Integrity Analyst Resume
1
Experience For Regional Revenue Integrity Analyst Resume
- Analytical and problem solving skills with the ability to function and complete assignments independently
- Works with the CHS divisions on any charge, revenue issues or concerns related to charge audits including investigating and resolving root cause issues
- Maintains knowledge of coding and billing guidelines, as defined by government and third party payer regulations and guidelines
- Assist management with maintaining and owning revenue controls
- Recommends and implements solutions to issues relating to technology incompatibilities, processes, deadlines, and budget constraints, escalating as necessary
- Responsible for estimating project resource requirements (i.e. staffing needs, time to completion, etc.)
- Provide any needed documentation to justify appeals including but not limited to letters of medical necessity and case briefs outlining disposition reversal
- Works closely with coding staff/HIM to ensure procedures performed are being accurately reported
2
Experience For Revenue Integrity Analyst / Linthicum, MD Resume
- Perform analysis and troubleshooting for charge capture / missing charge resolution and denial mitigation
- Monitor revenue and usage and Epic / EpicCare charging / billing data to monitor performance
- Provides education on available financial tools and resources and provides learning to non-financial staff so they can break down analysis in simple terms
- Reviews CDM change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges; imparts knowledge to facilities regarding requested changes
- Analyzes file data for evidence of deficiencies in controls, duplication of effort, or lack of compliance with laws, government regulations and policies and procedures; utilizes this data to mitigate risk and develop process improvements
- Collaborates with facility and/or other personnel to analyze CDM billing processes and identify root causes for claims issues/rejections; investigates complex issues as necessary; makes recommendations for solutions to management
3
Experience For Revenue Integrity, Analyst Resume
- Works with Information Systems and other departments to ensure that the appropriate CDM line-item charge and other necessary billing data are placed on the claim appropriately; evaluates ancillary or clinical systems related to revenue cycle, charge capture, and claims production
- Processes CDM additions, deletions and change requests while maintaining compliance with local, state and federal regulatory agencies
- Monitors various exception-based reports designed to catch billing mistakes and resolves where appropriate
- Utilizes the hospital’s cultural beliefs as the basis for decision making and to support the hospital’s mission and goals
- Conduct internal audits and review activities to improve the revenue cycle, claims production and coding integrity
- Prepare and present coding and operational materials at revenue cycle meetings
- Certification in CCS, CCS-P, RHIA RHIT, CPC, or specialty coding
- Works closely with the CHS charge master team on charging policy and procedures, education to the facilities and appropriate revenue by department
4
Experience For Senior Revenue Integrity Analyst Resume
- Provides support to all facilities on charge questions, training and education and charge reconciliation and capture
- Provides feedback and assist during the corrective action process
- Streamlines charge processes by the elimination of duplicate, inactive and non-compliant charges
- Implements CDM and/or charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs, reviews, and monitors statistics and key performance indicators to identify improvement opportunities
- Reviews, monitors, and facilitates implementation of billing and coding changes affecting CDM and charge capture processes in accordance with payor requirements
5
Experience For Revenue Integrity Analyst w Resume
- Serves as a subject matter expert and in a consultative role to various levels of customers; works closely and collaboratively with other internal departments
- Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes
- Plans revenue management strategies as identified in data/report analyses to ensure consistency/standardization, to identify improvement opportunities, and to facilitate appropriate education
- Reviews and evaluates CDMs, charge forms, charge screens, charge stickers and other charging vehicles, seeking to streamline the charge process by the elimination of duplicate, inactive and non-compliant charges; makes recommendations to management based on data analysis
- Maintains collaborative relationships with internal and external personnel to ensure integration and alignment of department priorities and Conifer core values
- Provides guidance and education related to billing and charge capture of services to multiple staff levels; facilitates proper recording of transactions in compliance with state, federal, and other third-party payor guidelines
- Responsible for the training of hospital departments regarding compliant charge practice; the CDM maintenance process; annual CPT/HCPC code updates; and charge capture improvement
6
Experience For Revenue Integrity Analyst Resume
- Performs detailed, annual review of the CDM and CPT/HCPC code changes and updates Meditech and Craneware systems
- Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes, including price analysis
- Serves as a subject matter expert and in a consultative role to various levels of customers including patient accounting systems; works closely and collaboratively with other internal departments
- Researches, evaluates, and interprets guidance from a variety of sources to determine department and/or facility impact; continually reviews and monitors billing and coding changes affecting CDM and charge capture processes, including price analysis. 40%
- Serves as a subject matter expert and in a consultative role to various levels of customers including patient accounting systems; works closely and collaboratively with other internal departments. 20%
7
Experience For Regional Revenue Integrity Analyst Resume
- Reviews CDM change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges; imparts knowledge to facilities regarding requested changes. 20%
- Provides guidance and education related to billing and charge capture of services to multiple staff levels; facilitates proper recording of transactions in compliance with state, federal, and other third-party payor guidelines. 10%
- Conducts special projects and special studies to facilitate revenue management as required for system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, etc. 10%
- Reviews CDM change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges; imparts knowledge to facilities regarding requested changes. 40%
- Identifies, researches, analyzes, review/analysis of pricing, resolves, and monitors CDM and charge capture processes to promote appropriate and consistent billing and coding practices. 20%
- Provides guidance, communication, and education to multiple levels of personnel on correct billing, coding, and charge capture processes for hospital services. 20%
- Assists in training new staff. Assists in coaching existing staff by building or enhancing individual skills or deficiencies. Provide one on one coaching or follow up training to staff as needed. 10%
- Effective communication (verbal and written) and presentation skills. Basic knowledge of spreadsheets and database applications required
8
Experience For Revenue Integrity Analyst / Linthicum, MD Resume
- Coding and CDM skills required
- Conducts annual CDM reviews with Clinical and Administrative Department Heads. Ensures the implementation of more frequent changes to comply with changing payor requirements and HSCRC methodology and RVU task force requirements
- Distributes key compliance transmittals to clinical departments. Conducts annual audit on clinical department’s daily charge reconciliation processes to ensure methodology is compliant with University of Maryland Medical System standards
- Reviews, monitors, and facilitates implementation of billing and coding changes affecting CDM and charge capture processes in accordance with payer requirements
- Identifies, researches, analyzes, review/analysis of pricing, resolves, and monitors CDM and charge capture processes to promote appropriate and consistent billing and coding practices
- Assists in training new staff. Assists in coaching existing staff by building or enhancing individual skills or deficiencies. Provide one on one coaching or follow up training to staff as needed
- Work in stressful, fast-paced environment
9
Experience For Revenue Integrity, Analyst Resume
- Able to work independently and follow established guidelines
- Assists with reports and tasks directly related to the charge master as assigned
- Performs reconciliation of data input in order to ensure accuracy of CDM
- Monitors assigned departments/service lines across all PHC entities to ensure compliance with corporate charge capture protocols and standards
- Conducts comparative charge data analyses at the procedure code level to identify pattern distribution variances; presents variance analysis to clinical service line leaders for validation; develops supplemental training materials to support appropriate charge determination practices
- Experience with CDM experience
- Collaborates effectively with diverse groups of people and various service departments throughout the organization
- Works closely with process owners to develop and implement remediation plans as necessary
10
Experience For Senior Revenue Integrity Analyst Resume
- Performs audits as assigned to ensure charges are supported by appropriate documentation
- Identifies and reports, negative, systemic charging patterns at the department/CDM code level throughout the Epic transition and beyond; continues monitoring outcomes until resolution is complete
- Assists clinical departments with the resolution of charge issues for Piedmont entities as necessary
- Develops technical specifications to address recurring claim edits and/or rejections related to charge capture process; submits to IT for resolution; monitors progress through testing and implementation phases
- Tracks and monitors charge review work queue inventory levels; escalate negative trends in excess of threshold values to superiors, or identified stakeholders
List of Typical Skills For a Revenue Integrity Analyst Resume
1
Skills For Regional Revenue Integrity Analyst Resume
- Articulate communicator with excellent written and verbal communication skills
- Effectively process and integrate primary and/or secondary data sources using database warehouse and visual applications
- Prior data analysis and project management experience
- Demonstrated knowledge of revenue cycle processes, medical terminology and related coding and charge capture processes
- Four years of financial management experience or graduate level finance course training
- Healthcare/finance experience, business office, admitting,
- Experience working in a revenue cycle department, required
- One year experience using basic SQL or other database programs
- Three years of operational performance improvement and/or project management experience
2
Skills For Revenue Integrity Analyst / Linthicum, MD Resume
- Three years of lead/supervisory/management experience
- Two years of performance improvement and/or project management experience
- Experience within a large hospital or integrated healthcare delivery system
- Experience with account management in a healthcare provider or payer environment
- A well-organized individual able to prioritize own work with minimal amount of direction
- Develop effective quality control processes to ensure data integrity
- Experience working in hospital business office or healthcare field
- Hearing / Listening, Manual Dexterity, Seeing, Speaking
3
Skills For Revenue Integrity, Analyst Resume
- Working knowledge of Microsoft Access and Microsoft SQL, Tableau, and other reporting tools
- Working knowledge of ambulatory surgery center patient accounting systems and revenue cycle process
- Uunderstanding in CPT/HCPCS methods
- Working knowledge of Microsoft Excel and advanced formulas
- Monitors Medicare and Medicaid web sites, as well as Payer websites and newsletters for changes impacting charging, coding and billing
- Reviews, monitors, and facilitates implementation of billing and coding changes affecting charge capture processes in accordance with payer requirements
- Assists Cash Posting team on matters involving remits, EOB's and any missing documents
4
Skills For Senior Revenue Integrity Analyst Resume
- Responsible for coordinating the activity of resources responsible for performing tasks in completing a project
- Highly analytical thinker with talent for scrutinizing and synthesizing diverse data sources to identify areas of improvement in the revenue cycle process
- Monitors pending revenue work queues and performance reporting to assist with the identification of issues, root cause analysis, and action plan development
- Moderate understanding of insurance billing
- Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues
5
Skills For Revenue Integrity Analyst w Resume
- Provides guidance, communication, and education to multiple levels of personnel on correct billing, coding, and charge capture processes for hospital services
- Develops additional charge capture policies, procedures and training materials as necessary to supplement and/or clarify existing documentation
- Assists on special reimbursement projects that have been elevated to the integrity team by analyzing payer spreadsheets and assisting with resolution of A/R
- Maintains payer set-up within the operating system(s), ensuring integrity of revenue and accuracy to contractual rates
- Responsible for identifying and logging any process or workflow issues in order to improve departmental efficiencies
6
Skills For Revenue Integrity Analyst Resume
- Works closely with Patient Accounting on billing edits/requirements that are payer specific
- Knowledge in AR ( Account Receivable) and Aging
- RHIT, CCS, CCP,CPC or other recognized AHIMA certified coding credential; other healthcare related credential such as (but not limited to) LPN, LVN or RT
- Assist with Charge Description Master (CDM) updates, including communication with departments, organization-wide stakeholders, and associated vendors
- Facilitates ongoing maintenance and review of the CDM and fee schedules
- Knowledge Revenue Cycle functions and of CPT and ICD coding
- Knowledge of regulatory billing requirements
- General knowledge of Charge description mater (CDM) and 837i, 837p and UB04 billing
7
Skills For Regional Revenue Integrity Analyst Resume
- Stay abreast of ongoing compliance trends and developments. Reports new developments to department
- Healthcare claims coding expertise (e.g. CPT, ICD-9, ICD-10, HCPCS)
- Certified Professional Coder (CPC) or Certified Outpatient Coding (COC), formerly CPC-H by the American Academy of Professional Coders, or
- Certified Coding Specialist Physician-based (CCS-P), or
- Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA)
8
Skills For Revenue Integrity Analyst / Linthicum, MD Resume
- Identifies, researches, analyzes, resolves, and monitors CDM issues to promote appropriate and consistent billing practices
- Yearly continuing education is required
- Identify front-end operation improvements and assist with the conduct re-retraining
- Collaborates with Revenue Integrity, Coding & Documentation, and Patient Financial Services to resolve denials as they relate to pharmacy charges
- Responsible for meeting departmental productivity and quality expectations
- Remains cognizant of all third party payor and governmental regulations and updates along with recommending revisions to policies and procedures
- Updates/adds items to the charge master to ensure appropriate charge capture after appropriate approvals and reporting through Craneware
- Identifies opportunities for capturing additional revenue in accordance with payer guidelines
9
Skills For Revenue Integrity, Analyst Resume
- Coordinates and provides documentation for all external billing audits
- Makes recommendations to case management, physicians and nursing staff on documentation improvements
- Serves as a backup for reporting for the Decision Support Analyst
- Query and other AS400 related programs
- Knowledge of Cerner application
- Ensures the appropriate bundling or unbundling of charges so that all charges result in optimal reimbursement while following applicable billing, coding, and reimbursement regulations
- Assists facility department billing personnel in resolving third party payor billing issues
- Reviews Medicare intermediary and other third party payor bulletins to keep current on billing requirements
- Utilizes a solid understanding of the EDW, Intermountain data platforms, and coding and charging rules to develop and automate reports for Revenue Integrity and other hospital departments
10
Skills For Senior Revenue Integrity Analyst Resume
- Thorough understanding of the CDM relationship to general ledger, cost accounting, cost reporting, budget, coding, billing and compliance in a hospital setting
- Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint), including creating charts and graphs
- Participates actively in the Corporate SQL group
- Provides training to other facility RI Analysts on using Intermountain software including how to run reports, finding APC issues, running comparative pricing reports, etc
- Shift Department: Revenue Integrity
List of Typical Responsibilities For a Revenue Integrity Analyst Resume
1
Responsibilities For Regional Revenue Integrity Analyst Resume
- Develops and maintains "super user" capabilities in Epic applications and all other related information systems, tools, technologies, and processes (including assigned clinical service lines); assist other employees as needed to ensure all tools are fully utilized to create an efficient and effective department
- Delivers positive patient experience, where applicable
- Maintains collaborative relationships with internal and external teams to ensure integration and alignment of department priorities
- Maintains daily focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate
- Analyzes and verifies charging procedures, charge capture tools and processes, and charge reconciliation
2
Responsibilities For Revenue Integrity Analyst / Linthicum, MD Resume
- Adheres to Piedmont organizational policies and procedures for relevant location and job scope
- Initiates refund request and provides any required documentation required for refund
- Assist with special projects on as-needed basis
- Provides onsite support and assistance for new practices; train the staff on workflows and EPIC Charge and Edit work queues
- Monitor the Ambulatory Open Encounters report to ensure that charges are submitted timel
3
Responsibilities For Revenue Integrity, Analyst Resume
- Provides guidance and education related to billing and charge capture of services to multiple staff levels; facilitates proper recording of transactions in compliance with state, federal, and other third-party payer guidelines
- Performs charge reconciliation process to ensure that charges are captured
- Performs various financial analyses and provides recommendations based on activities. Review monthly FGP revenue cycle metrics for areas of improvement within practices
- Implements charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs, reviews, and monitors statistics and key performance indicators to identify improvement opportunities
- Works directly with Faculty Practice Billing Coordinators on developing and maintaining solvency within each practices revenue cycle. Review, monitors and tracks charge and edit work queues of each billing coordinator and provide support if needed
- Conducts internal audits and reviews activities to improve the revenue cycle, claims production and coding integrity
- Supports operational implementation of regulatory changes and payer requirements
- Liaises with different ancillary systems (EPIC, SDK, MedAssets, Pyxis, Talyst, etc.) as needed
- Evaluates and processes requests to establish charge codes or updates to CDM content requested by revenue-producing departments, considering system-wide policies and procedures, as well as requirements of third party payers
4
Responsibilities For Senior Revenue Integrity Analyst Resume
- Ensures consistency and accuracy of facility CPT, HCPC and Revenue codes within the CDM and coordinates Willow content and EAP assignment
- Perform various assessment, analytical research, and support including, but not limited to: root-cause, analyses, cost/benefit analyses, and financial projection either in lead role or as key participant
- Maintain professional skills and knowledge through attendance at in-service programs, conferences, workshops and other educational programs and review of current literature
- Participates in hospital wide quality improvement activities
- Adheres to all the principals of BMC’s RESPECT Behavioral Standards
- Works directly with Faculty Practice Billing Coordinators on developing and maintaining solvency within each practices revenue cycle. Review, monitor and track charge and edit work queues of each billing coordinator and provide support if needed
- Implement charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs, reviews, and monitors statistics and key performance indicators to identify improvement opportunities
5
Responsibilities For Revenue Integrity Analyst w Resume
- Performs various financial analyses and provide recommendations based on activities. Review monthly FGP revenue cycle metrics for areas of improvement within practices
- Maintain collaborative relationships with internal and external teams to ensure integration and alignment of department priorities
- Review, monitor, and facilitate implementation of billing and coding changes affecting charge capture processes in accordance with payer requirements
- Provide guidance and education related to billing and charge capture of services to multiple staff levels; facilitate proper recording of transactions in compliance with state, federal, and other third-party payer guidelines
- Conduct special projects and special studies to facilitate revenue management as required for system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, etc
6
Responsibilities For Revenue Integrity Analyst Resume
- Analyze billing error and denial data to identify root causes. Execute on work plans to correct identified deficiencies
- Lead and participate in moderately complex projects related to revenue cycle initiatives
- Monitors payer websites for changes related to revenue cycle processes (including but not limited to medical policies, claims submission procedures, authorization requirements) and distributes information to applicable personnel
- Acquires information on new contracts as well as quarterly fee schedule updates and updating systems accordingly
- Communicates with finance and RCM on any payer fee changes in the system
7
Responsibilities For Regional Revenue Integrity Analyst Resume
- Assists Finance department with maintaining relationship with the bank; completes change forms as needed; analyzes current payers to ensure all are transitioned
- Serves as a liaison with vendors (e.g. CPR+/Mediware, ZirMed, Emdeon, NaviNet) as needed when information relating to data, analysis, and payer processes is involved
- Serves as administrator for provider web portals and vendors. Ensures associates have access to portal logins. Resets passwords and accounts as necessary
- Identify, implement, and report opportunities to improve processes, procedures, systems, and/or organizational structures
- Serves as a liaison to Contracting Department and payers, receiving and entering new contracts, providing requested information, resolve escalated concerns, and support as requested
8
Responsibilities For Revenue Integrity Analyst / Linthicum, MD Resume
- Keeps current with industry knowledge, including but not limited to healthcare payers, changing requirements (e.g. authorizations, billing, and reimbursement); sources and attends training sessions as needed to maintain knowledge
- Seeks out opportunities for individual growth and development, including attending various meetings, conferences, and courses, as required
- Support Accounting, Financial Operations, and Revenue Cycle with development, implementation, and maintenance of operational reports and dashboards
- Assist management with special projects and/or ad hoc revenue reporting needs
- Create and maintain revenue reporting that utilizes MS SQL Server, Tableau, and other BI tools
9
Responsibilities For Revenue Integrity, Analyst Resume
- Responsible for analyzing data to identify likely relationships, summarizes data and prepares summary materials for discussion with clinical and finance teams
- Escalates any payer issues to appropriate management personnel
- Intermediate level healthcare claims experience, including but not limited to professional claims and pharmacy claims (e.g. electronic data interchange, CMS1500, NCPDP)
- Interpret health plan contracts and corresponding requirements
- Knowledge of healthcare reimbursement methodologies
- Decisive with a detail-oriented perspective
- Solution-oriented individual with approach to problems
- Assists with reports and tasks directly related to the chargemaster as assigned
10
Responsibilities For Senior Revenue Integrity Analyst Resume
- Perform comprehensive analytical reviews of facility-level revenue financial reports
- Fosters teamwork and utilizes strong team building measures. Develops and maintains project plans and project tracking, including documentation of all project meetings and project issues lists
- Responsible for preparing materials for and conducting project meetings
- Participates in and fosters a performance improvement approach that includes all Revenue Cycle departments
- Participates in the development and implementation of Revenue Cycle policies and procedures
- Serves on department and/or institutional committees as requested
- Maintains knowledge of current trends and developments in the field by signing up for related list serves, reading journals, other literature, and attending seminars
- Knowledge of procedure, diagnosis, and revenue codes
- Reviews records for medical necessity, accurate patient class, physician orders, level of care to determine course of action to overturn insurance carrier denial or resolve customer service inquiries
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