Revenue Integrity Analyst, CDM

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

📋 Description

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

• Input any missing hospital charges based on the relevant medical documentation.

• Assess charge capture opportunities and identify necessary charge adjustments.

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

• Offer analytical assistance regarding third-party payer reimbursement and contract adherence.

• Conduct quality control audits to maintain the integrity of data and documentation.

• Analyze accounts that qualify for Revenue Guardian edits and gather data by clinical department for educational purposes.

• Act as a Subject Matter Expert for leadership on Revenue Integrity matters.

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

• Monitor data trends to affirm the effectiveness of documentation improvement initiatives and enhance charge capture.

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

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

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

• Review charges and payments for accuracy from contracted payers.

• Oversee the appeals process with designated payers in both hospital and clinic environments.

• Identify revenue opportunities through the use of reporting tools.

• Perform additional related tasks as necessary.

⛳️ Requirements

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

• A minimum of 3 years of experience in coding is required.

• Coding certification (e.g., CPC, CCS, RHIA, RHIT) is mandatory.

• Comprehensive understanding of Medicare/Medicaid regulations, including billing, coding, and documentation requirements.

• Experience in Revenue Cycle management.

• Excellent oral and written communication skills.

• Research-oriented with the capability to critically analyze and interpret large datasets.

• Charge capture, reporting, and analysis experience is preferred.

🏝️ Benefits

• Equal Opportunity Employer.

• Reasonable accommodation information and support for essential physical job functions.