Revenue Integrity Analyst

Scheduled Weekly Hours:

We are seeking a detail-oriented and knowledgeableRevenue Integrity Analystto join our Mid-Revenue Cycle team. This critical role is responsible for identifying revenue opportunities, resolving process inefficiencies, and implementing system enhancements to optimize revenue cycle performance. The analyst will collaborate closely with clinical leadership, revenue cycle teams, and IT to ensure accurate and compliant billing practices across all services.

Major Responsibilities:

• Researches and analyzes both professional (PB) and Facility (HB) claims prior to new clinical services being added to ensure the appropriate reimbursement of claims. This includes all payors; to see that government regulated billing rules and payer policies are being reinforced.

• Collaborates with Clinical Operation Directors and Clinical leaders to perform charge reconciliation to ensure performed visits, procedures, and tests are appropriately billed.

• Collaborates with Clinical Operation Directors and Clinical leaders to create mitigation plans for charges that are not entered in a timely fashion to ensure we are not at risk for revenue loss.

• Interprets existing revenue cycle policies and operating practices to make recommendations for improvement.

• Demonstrates in depth knowledge and technical expertise in CPT, HCPCS, ICD-10, as well as, current payer policies for coding, billing and claims processing, and provider-based billing rules.

• Serves as the point of contact for complicated billing scenarios to establish proper process(es) to get the claim filed.

• Facilitate multi-department billing steering committee.

• Oversees and helps maintain the Revenue Guardian Edits in Epic.

• Reviews Epic Dashboards to ensure all charges are captured in a timely manner, are in compliance with state and Federal guidelines and are achieved within expected window after patient discharge.

• Identifies and works with Information Systems to rectify any claims data transmissions issues as they arise and track any changes.

• Creates, generates, and maintains ad hoc reports proactively and as requested on various transactions to ensure consistency on claims submissions and to direct chargemaster analyst as needed to update clinical charge capture in Epic.

• Maintains extensive knowledge of current EHR technical and professional billing software modules and how it relates to all payer processes.

• Collaborates closely with all Revenue Cycle leaders on processes, procedures, and defining improved workflows for billing and reimbursement practices and appropriate claims submission.

• Collaborates with Compliance on governmental regulated billing rules and policies to ensure new services are set up appropriately.

• Develops and provides education to staff on technical processes for account completion, correct addition of charges, and charge cloning/splitting process.

• Effectively utilizes the project management tool and quality assurance methods to complete a variety of Manager assigned projects within time and resource constraints.

• Applies and appropriately uses performance enhancing tools (cause-effect diagrams, flow charts, brain storming, A3), problem analysis (control charts, run charts, financial analyses) and measurement.

If you need assistance with any portion of the application or have questions about the position, please contact HR-Recruitment@gundersenhealth.org or call 608-775-0267.

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Equal Opportunity Employer