Revenue Integrity Charge Analyst

January 24

🌴 South Carolina – Remote

Although this job is listed in South Carolina, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Tidelands Health

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Tidelands Health is a comprehensive healthcare provider offering a wide range of medical services and treatment options. With over 200 providers and four hospitals, along with more than 70 outpatient locations, Tidelands Health delivers expert care in specialties such as family medicine, orthopedics, heart care, cancer care, women's care, and more. The organization emphasizes community health, offering resources and support for those impacted by local events, such as the International Paper Mill closure. Tidelands Health also engages the community through educational events, support groups, and health improvement initiatives.

Hospital • Health • Fitness • Nutrition • Nurse

1001 - 5000 employees

⚕️ Healthcare Insurance

📋 Description

• Performs daily review of revenue integrity work queues to ensure departments are charging appropriately and revenue posted is correctly. • Provides guidance, communication and education on correct charge capture, coding and billing processes to clinical departments leaders and providers. • Analyzes business, clinical, and coding processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future losses and optimize reimbursement based on compliance standards. • Performs pricing reviews for hospital and professional billing. Maintain and update the Charge Description Master (CDM) to ensure it is accurate, complaint, and reflective of current clinical services and procedures. • Participate on performance improvement activities, including conducting routine charge capture reviews of revenue generating departments and implement any suggested changes once approved by Director of Reimbursement. • Perform data collection, tracking and analytical duties to respond to key issues to increase revenue integrity and process efficiency in support of the strategic initiatives and goals. • Work collaboratively with clinicians and revenue cycle teams to understand services provided, explore and capitalize on opportunities for enhanced revenue integrity, minimize charge leakage and maximize compliant reimbursement. • Investigate/research and advise on matters relating to professional/technical billing, coding, or regulatory requirements for documenting, coding, and billing. • Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, CMS, etc. Coordinates communication with the Director of Reimbursement regarding regulatory or payor changes to impacted leaders. • Contribute to departmental and organizational special projects as assigned; including but not limited to, price transparency, PAMA analysis, etc.

🎯 Requirements

• Bachelor's Degree from an accredited college or university. • Certification in healthcare compliance (HCAA or AAPC's certification) and/or Coding Certification (RHIA, RHIT, CPC or CCS), preferred. • Current and in good standing RN Licensure with South Carolina Board of Nursing, preferred • Experience in hospital charging/billing or performance charge review preferred • Knowledge of CPT/HCPCS coding rules, Charge Master build/maintenance, Clinical charging practices, and billing regulations and practices. • Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance. • Possesses working knowledge of various payment and coding systems, particularly IPPS, OPPS, HCPCS and CPT coding schemes. • Experience working with EPIC HER • Experience in multi-hospital organizations. • Experience with Optum 360 CDM Master.