Revenue Integrity Analyst III - 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.

EXPERIENCE | EDUCATION:

REQUIRED:

• Bachelor's degree in relevant field preferred or combination of equivalent of education and experience
• Six (6) years coding experience including but not limited to hospital outpatient encounters.
• One (1) year of experience preparing and delivering education as it relates to audit findings or regulatory guidance to coders and auditors.
• AAPC Coding Credential, including Certified Professional Coder required.

JOB DUTIES:

• Proactively identifies charging opportunities.
• Understands charge master set up and maintenance requirements including EPIC build.
• Understands and is articulate in communicating processes and documentation requirements for accurate and compliant charge capture.
• Works collaboratively with clinical areas, Finance, Health Information Management, Information Services, PFS, Patient Access to identify and resolve charging issues and opportunities when applicable.
• Knowledge of ICD-10-CM, CPT/HCPCs procedure coding along with UB-04. Partners with Compliance in reviewing government and third-party payer regulations and requirements and alerts appropriate clinical/department leadership to changes.
• Provides training and education to department leadership, staff, and mid-levels and faculty on Revenue cycle related topics particularly around the areas of charge entry and use of charge codes for their respective areas.
• Does on going monitoring and auditing of areas assigned to ensure appropriate charging.
• Establishes, maintains, and conducts periodic analysis of overall pricing policies around annual charge increases, algorithms for product and drug and services pricing, and price estimation process.
• Participate in UTSW revenue cycle committees and related work groups.
• Provide input for revenue cycle process improvement initiatives.
• Operationalizes key reimbursement information from Third party Contracts for medical and professional services provided by UTSW.
• Maintain extensive knowledge of ICD-10-CM, CPT/HCPCs procedure coding along with UB-04 billing requirements.
• Monitor federal, state, and local regulations and collaborate with appropriate managers on changes.
• Perform periodic training and education to department managers and staff on revenue cycle related topics.
• Analyzes reports to identify aged or problem accounts.
• Able to manage large projects with minimal oversight.
• Ad hoc reporting as requested.
• Other duties as assigned after appropriate training.

KNOWLEDGE, SKILLS, & ABILITIES

• Proficiencies: Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs. Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10. Extensive knowledge of NCCI edits, and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG, OPPS, HCC, and managed care. Extensive working knowledge of health care compliance. Extensive understanding of medical terminology, anatomy, and physiology along with clinic department activities. Capacity to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations along with facilitating to all member entities. Ability to work with and interpret detailed medical record documents and communicate effectively with physicians, nursing staff, leadership, and other billing personnel.
• Abilities: Requires the ability to manage large complex projects assignments, investigate, analyze, and resolve issues at a high level. Excellent communication, presentation, organizational, analytical, and problem-solving skills. Must approach problem solving challenges independently, have strong attention to detail and enjoy working in a fast paced, collaborative team-based environment. Computer skills - MS Office including Word, PowerPoint, Excel, and Outlook; Windows operating system and Internet.
• Knowledge of third-party requirements, state, and federal regulations.
• Knowledge of payer enrollment processes.
• Knowledge of government and commercial payer requirements for accurate and compliant charging and billing of hospital inpatient, outpatient, surgical and ancillary services.
• Knowledge of CPT, HCPCs, and revenue codes.
• Experience with Microsoft Office (Outlook, Word, Excel, Power point, Access).
• Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting)
• Knowledge of regulatory publications, how to access and interpret.
• Knowledge of medical terminology.
• Strong analytical and problem-solving skills
• Ability to work independently, prioritizing and organizing their work.
• Strong verbal and written communication skills.
• Ability to project manage small to medium projects.

WORKING CONDITIONS

Work is performed primarily in a hospital office setting.

SECURITY:

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

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.