The Revenue Integrity Analyst reports to the Manager of Pathology Informatics and VP of Laboratory Services. Under general supervision is responsible for resolving claim edit issues specific to payors handling claim edit issues new payor policies CPT and HCPCS and modifier edits. The analyst position is responsible for ensuring the accuracy of coding billing and revenue optimization for lab services. By maximizing revenue and ensuring compliance the Revenue integrity Analyst will play a vital role in supporting the financial health and success of our organization�s Pathology services.
The Revenue Integrity Analyst is responsible to monitor investigate and resolve revenue integrity concerns and violations identified by the Revenue Integrity Department or by other departments. .Analyst will monitor national state and local information to keep current with applicable regulatory and legislative changes.
1. Revenue Coding: Accurately audits and identifies improvement opportunities for Laboratory services rendered including diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) ensuring compliance with regulatory guidelines such as those set forth by CMS (Centers for Medicare & Medicaid Services). Updates database for Dex-Z coding to ensure reimbursement from insurance vendors.
2. Manual Billing � Performs manual billing and maintains files related to reference lab services keeping track of monthly spend and volumes for review.
3. Billing Analysis: Reviews and analyzes laboratory billing processes to identify any discrepancies or inefficiencies that may impact revenue generation. Conduct regular audits to ensure billing accuracy and compliance with payer requirements.
4. Charge Capture: Collaborating with AP CP and Outreach leadership to ensure complete and timely capture of all laboratory-related charges including ABN medical necessity and prior authorization for diagnostic tests procedures and other billable services.
5. RevenueOptimization:Analyzefinancialdataandperformancemetricsrelatedtothepathologyservicelinetoidentifyopportunitiesforrevenueenhancementandcost containment. Works with lab leadership to review procedural revenue reports to assess for opportunities for improving reimbursement.
6. Documentation Improvement: Work closely with pathology leadership to improve documentation practices for procedures ensuring completeness accuracy and compliance with coding and billing requirements. Ensures that clinical documentation supports the services billed including thorough documentation of medical necessity and compliance with coding guidelines and documentation requirements.
7. Data Analysis and Reporting: Generate reports and analyze data related to Laboratory revenue cycle performance identifying trends opportunities for improvement and areas of risk. Providing recommendations for process enhancements and revenue optimization strategies based on data insights.
8. Regulatory Compliance: Staying abreast of changes in healthcare regulations coding guidelines and payer policies related to laboratory services. Implementing necessary updates to coding and billing processes to maintain compliance and mitigate risks.
9. Training and Education: Providing training and education to providers and laboratory staff on coding documentation and billing best practices to support revenue cycle integrity and compliance.
10. Collaboration: Collaborating with cross-functional teams including healthcare providers revenue cycle management compliance and IT departments to streamline processes resolve issues and ensure seamless revenue cycle operations for the laboratory service line. Serves as the point person for all coding and documentation processes within services.
11. Performance Analysis: Monitor key performance indicators (KPIs) and financial metrics for the Laboratory department service line providing regular reports and analysis to management to support informed decision-making.
12. Prepares monthly quality (accuracy) and productivity reports.
13. Maintains knowledge of current professional coding certification requirements and maintains level of knowledge and expertise pertinent to the position.
14. Performs related clerical duties and other related duties as required.
15. Projects - Affirmatively promotes project objectives direction and achievements fostering collaboration and teamwork and acting as a positive resource for all team members. Assists in coordinating communications within and among multi-disciplinary teams vendor representatives project leadership users and other stakeholders
16. Develop recommendations for changes to operations which result in automated solutions that are logical economical practical and responsive to needs of users.
BASIC KNOWLEDGE:
High School Diploma required Associate Degree or preferred or equivalent experience.
Coding certification preferred from the American Health Information Management Association (AHIMA [RHIA RHIT CCA CCS or CCS-P] or the American Academy of Professional Coders (AAPC) [CPC or CPC-H] or strong experience in Revenue Cycle experience specializing in billing and follow-up. Requires knowledge of payor policies chargemaster hospital & professional payor reimbursement LCD and NCDs modifiers and 837 INP files.
EXPERIENCE:
At least five years of experience in healthcare with aheavy emphasis in one of the following areas: Lab Billing and follow-up Coding Hospital and Physician Revenue Cycle. Proficient in Microsoft Office specifically MS Excel Outlook and PowerPoint and Epic. Highly organized with strong project management skills including the ability to meet deadlines effectively communicate with all levels of the organization and work as part of a team.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Work is performed in a typical office setting.
INDEPENDENT ACTION:
Ability to work with minimal supervision. Proactive approach to the resolution of problems issues etc. Performs independently within department policies and practices. Refers specific complex problems to manager where direction may be required.
SUPERVISORY RESPONSIBILITY:
None
