Revenue Integrity Analyst - Decision Support

JOB SUMMARY:

Why UT Southwestern?

With over 75 years of excellence UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued patients and employees. With over 20,000 employees, we are committed to continuing our growth with the best professionals in the healthcare industry. We invite you to be a part of the UT Southwestern team where you'll discover teamwork, professionalism, and consistent opportunities for growth. There is a new opportunity available with the Department of Decision Support for the role of Revenue Integrity Analyst III.

The ideal candidate for this role duties may include but not limited to the following:

• Collaborates to support the maintenance and enhancement of charge capture and overall billing functions.
• Explore potential charge capture workflow enhancements, consistent charge structure and rate setting according to industry standards and payer contracts, and denial trends.
• Support Epic implementation and analytic processes across departments and service lines.
• Maximizes charge efficiency through: (1) Monitoring revenue cycle processes; (2) Supporting revenue capture and integrity through evaluating the accuracy of charge capture and billing functions
• Stay apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of charge capture/billing workflow improvements.
• Identifies revenue and reimbursement opportunities while maintaining compliance with state, local and federal regulations.
• Work autonomously but able to call upon colleagues as needed
• Ability to work autonomously
• May collaborate with nurses who bring a vast clinical knowledge as an Analyst

Shift: 8-hour days, flex shift

Work From Home: This is a WFH position. Preference to candidates who reside within Texas.

Quick Tips:

• Please review the experience/education section thoroughly to verify that you qualify.
• Please list all applicable experience on your application to make sure we credit you properly.

EDUCATION/EXPERIENCE In excess of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management. EPIC HB/PB experience preferred. Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and +five (5) years of experience within the revenue cycle. Experience above minimum requirement will be considered in lieu of education Applicable professional certification through AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC) Pharmacy Technician (CPhT, PTCB), or Licensed Vocational Nurse (LVN). JOB DUTIES 1. Responsible for conducting quality control audits to ensure data/documentation integrity, and communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. 2. Compile information and/or prepare reports and analyses setting forth results of date integrity findings with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action. 3. Follow up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop education strategies to promote complete and accurate clinical documentation and correct negative trends. 4. Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections. 5. Monitors EPIC Revenue Integrity Dashboards. Serves as subject matter expert to leadership on issues related to Revenue Integrity. 6. Train and assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation. 7. Stay abreast of ongoing compliance trends and developments. Reports new developments to department. KNOWLEDGE, SKILLS, & ABILITIES Work requires knowledge of RI processes and hospital/medical billing to include CDM, UB, RAs and 1500 Work requires advanced knowledge of code data sets to include CPT, HCPCS and ICD 10 Work requires advanced knowledge of NCCI edits and Medicate LCD/NCDs Work requires comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care Work requires ability to work with confidential information on a daily basis. Work requires ability to review, analysis and interpret managed care contracts, billing guidelines and state and federal regulations Work requires good interpersonal, organizational, and analytical skills. Work requires demonstrated ability to manage multiple projects and exercise decision-making and problem solving skills. Work requires ability to read, write, develop plans, procedures, and coordinate persons and other resources to accomplish goals. Work requires ability to communicate clearly. Work may require telephone and personal contact with all levels of internal and external personnel and organizations.
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status