Revenue Integrity Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Assist in enhancing revenue integrity and optimizing charge capture initiatives within Duke Health's Charge Description Master team.

• Assess pre-bill accounts identified through Epic Revenue Guardian edits.

• Input missing hospital charges based on relevant medical documentation.

• Analyze charge capture opportunities and establish suitable charge corrections.

• Formulate strategies for the implementation of new Revenue Guardian edits to mitigate revenue loss.

• Offer analytical assistance pertaining to third-party payer reimbursements and contract compliance.

• Execute quality control audits to guarantee data and documentation accuracy.

• Track accounts eligible for Revenue Guardian edits and compile results by clinical department for educational purposes.

• Act as a subject matter expert for leadership on Revenue Integrity matters.

• Create monthly reports and educational presentations for clinical departments and Revenue Manager teams.

• Monitor data trends to confirm improvements in documentation and charge capture efforts.

• Follow up with healthcare team members to ensure thorough and accurate medical record documentation.

• Collaborate with operational leaders to devise educational strategies for providers and service lines.

• Utilize root cause analysis to address negative trends and behaviors.

• Review charges and payments from contracted payers for accuracy and manage the appeals process.

• Identify revenue opportunities using reporting tools.

• Carry out other related responsibilities.

⛳️ Requirements

• Bachelor's degree in business administration, accounting, management, healthcare administration, nursing, or a closely related field.

• Minimum of 3 years of experience in a coding-related role.

• Coding certification is mandatory, such as CPC, CCS, RHIA, or RHIT.

• Extensive knowledge of Medicare/Medicaid regulations, including billing, coding, and documentation requirements.

• Experience in Revenue Cycle.

• Excellent oral and written communication skills.

• Research-oriented with the capability to critically analyze and interpret large volumes of data.

• Experience in charge capture, reporting, and analysis is preferred.

🏝️ Benefits

• Equal opportunity employer.

• Commitment to collaboration, innovation, creativity, and fostering a sense of belonging.

• Reasonable accommodation information and provisions are available upon request.