REVENUE INTEGRITY SPECIALIST - CREDENTIALED
Req #: 206433 Department: REVENUE INTEGRITY - UW MEDICINE Posting Date: 09/06/2022 Closing Info: Open Until Filled Salary: Salary commensurate with education and experience Shift: First Shift
UW Medicines mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrows physicians, scientists and other health professionals.
A higher degree of healthcare.
All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored.
UW Medicines mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrows physicians, scientists and other health professionals.
Become part of our team, and join our mission to make life healthier for everyone in our community.
UW MEDICINES REVENUE INTEGRITY DEPARTMENT has an outstanding opportunity for a REVENUE INTEGRITY ANALYST - CREDENTIALED.
The Revenue Integrity Analyst is responsible for promoting revenue enhancement and compliance with billing regulations through the performance of charge audits ensuring complete documentation and accurate charge capture and timely billing. The Revenue Integrity Analyst will also be responsible for performing charge audits on patient charts (ie. Medical Record) upon request from leadership for reasons for treatment, payment or operations.
RESPONSIBILITIES:
Identify charge capture/reimbursement issues and resolutions using available mechanisms [Epic BOE SSRS reports, Revenue Guardian, etc.] and performs validation through comprehensive chart review to identify missed/erroneous charges
Perform analysis and troubleshooting for charge capture / missing charge resolution and denial mitigation.
Monitor revenue, usage, and Epic / EpicCare charging / billing data to monitor performance (i.e., KPIs); identify, report and rectify patterns and trends
Assist with and document the development of new operational procedures / processes related to Charge Capture and Charge Reconciliation
Summarize and provide report-outs to applicable functional areas, clinics and departments on charge capture opportunities
Develop training resources and facilitate proactive charge capture and reconciliation education to ensure complete and accurate charge capture
Conduct trend analysis to identify patterns in audit requests and outcomes for medical necessity, coding and billing practices
Perform analysis and troubleshooting for denial mitigation
Assist with and document the development of new operational procedures / processes related to denial management
Summarize and provide report-outs to applicable functional areas, clinics and departments on denial management
Disseminate and communicate training and education collateral related to denial management
Provide regular status to management and key stakeholders by book of business. Information should be accurate, timely and pertinent.
Perform root-cause denial analysis and provide process improvement recommendations for reduction to clinical departments or other ERCO departments as needed.
Perform daily maintenance and quarterly audits of Epic Charge Review, Charge Router, Account Workqueues and Error Pool
Review the Revenue Integrity specific Epic workqueues for issue resolution; review for trends/recurring issues and identify required remediation efforts
Provide feedback to applicable clinical depts. regarding issues identified and facilitate discussions to further identify root cause(s) and resolution(s)
Provide functional expertise to implement resolution processes and drive accountability to the appropriate areas
Partner with HIM, Coding, Epic Core Team, Revenue Cycle and Clinical teams to support performance improvement opportunities
REQUIREMENTS:Bachelor's Degree in Health Information Management/Business (or Equivalent applicable experience in HIM / Coding / Charge Capture and / or as a Hospital Clinic / Department manager, supervisor or charge lead role.) and AND 4-5 years work experience or equivalent
Additional Requirements:Knowledge and experience with Medicare/Medicaid and CMS regulations
3 years of Epic Experience (HB Resolute, Willow, OpTime, ClinDoc, Radiant, Cupid, Beacon)
Candidate possesses any of the following credentials: RHIA/RHIT/CCS/COC/RN or other related healthcare credential
At least five years experience in the healthcare industry. Extensive experience in with hospital billing or reimbursement. Understanding of CMS regulations and ability to interpret healthcare guidelines and regulations.
Proven analytical, verbal and written communications skills.
DESIRED:Experience working in HIM / Coding and / or Revenue Cycle
Clinic Operations or Outpatient department expertise from working in specialty clinics or departments is desired
Epic Certifications (HB Resolute, Willow, OpTime, ClinDoc, Radiant, Cupid, Beacon).
Utilization Review or Case Management experience.
UW Medicine includes Harborview Medical Center, UW Medical Center - Montlake, UW Medical Center - Northwest, Valley Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest.
REQUIREMENTS: see above
Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.
Committed to attracting and retaining a diverse staff, the University of Washington will honor your experiences, perspectives and unique identity. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable and welcoming.
