Sr. Revenue Integrity Analyst (CCS/CPC/CCA/RHIT) - On-site position Job at NorthEast Provider Solutions Inc., Valhalla, NY

S0pqRnhoRVBCWUIwaXlWdCtvdktoZ0FxT2c9PQ==
  • NorthEast Provider Solutions Inc.
  • Valhalla, NY

Job Description

Job Details:

Job Summary:

The on-site Sr. Revenue Integrity Analyst reviews and revises accounts to achieve revenue enhancement and compliance. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing. The incumbent establishes and maintains a library of rule, regulations, policies and procedures of all governmental and commercial payors.

Responsibilities:

  • Assist various departments in ensuring all denials are captured & appealed in a timely manner. Coordinating appeal discussions with clinical & third party payors.
  • Develop, Implement and coordinate billing practices between hospital and physician groups to ensure uniform coding and documentation.
  • Recommend sound financial best practices that are able to withstand audits.
  • Foster continuous improvement of revenue cycle processes through education with various departments.
  • Identify pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered.
  • Analyze and maintain WMCHealth Network Hospitals CDM’s to maximize revenue.
  • Performs periodic review of codes and works with patient billing regarding bundling and unbundling services as delineated in CMS and CCI edits.
  • Coordinates and serves as liaison with CDM software companies to evaluate and validate CPT and revenue codes and related coverage issues.
  • Engage with various departments to identify opportunities during EMR implementation and provided feedback and recommendations.
  • Serves as the finance liaison with ancillary departments regarding CDM service and procedure changes and educates departments regarding the impact of CDM regulatory changes.
  • Researches technical guidance in UB-92 Editor, CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance.
  • Maintains and provides information on status of audits and issues presented.
  • Participates in quantifying audit outcomes, including revenue realized
  • Researches and communicates appropriate treatment of charges to clinical managers, CDM Specialist (coordinator), other customers.
  • Participates in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
  • Performs other duties as assigned.
Qualifications/Requirements:

Experience:

Minimum 8 plus years clinical experience in a hospital setting, preferably cardiology, radiology, surgery or utilization review, required. Previous revenue integrity experience, Excel and Electronic Medical Records experience preferred.

Education:

Graduate of an accredited program (RN,MD,PA), degree in healthcare preferred. Bachelor's degree or equivalent work experience (8 plus years) required.

Licenses / Certifications:

Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H), preferred.

Other:

Familiarity with medical record documentation standards and practices, health care insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and ICD-9-CM codes is preferred. Special Requirements: Requires travel to other WMCHealth Facilities.

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

  • Health Insurance
  • Dental
  • Vision
  • Retirement Savings Plan
  • Flexible Savings Account
  • Paid Time Off
  • Holidays
  • Tuition Reimbursement

 

Job Tags

Holiday work, Full time, Work experience placement, Flexible hours,

Similar Jobs

Cal Farley's Boys Ranch

Summer Recreation Program Assistant Job at Cal Farley's Boys Ranch

 ...Assists in the operation and supervision of the Recreation Summer Program in the capacity of full-time, temporary assistant. Requirements Job Specifications 1. A high school diploma or GED equivalency is required. 2. Prior experience in youth recreation... 

Yen Oral Surgery

Surgical Assistant - Oral Surgery Job at Yen Oral Surgery

 ...Yen Oral Surgery | Milpitas, CA Dental Assistant Oral Surgery Surgical Assistant Oral Surgery This position is based in the office. It is not hybrid or remote. Position Highlights: Step into the fast-paced world of oral surgery as an Oral Surgeon Surgical... 

Concept One Accessories

Assistant Designer Job at Concept One Accessories

 ...licensing partners in each segment of business. Who We Are Looking For: We are seeking a creative and detail-oriented ASSISTANT DESIGNER in our New York City office to collaborate with our Senior Designer in the development of innovative fashion accessory... 

Interim HealthCare - FL Panhandle

Home Health Aide, Private Duty for 1 Client, 30 Hrly wkly Job at Interim HealthCare - FL Panhandle

Current opening in Crestview FLInterim Health-Care is looking for an extremely motivated Home Health Aide to provide Private Duty Care for 1 Client in Crestview, 30 hrs weekly* Excellent Communication* Assist client with ADLs and maintaining a clean and safe environment... 

Optimum Healthcare IT

Entry Level IT Analyst Job at Optimum Healthcare IT

 ...Entry Level Healthcare IT Analyst Start Your Career in Healthcare Information Technology Today! Getting your rst job can be difcult...  ...applications (Tableau, PowerBI), cloud deployments (GCP, Azure, AWS), and other digital platforms and services. Requirements:...