The Revenue Integrity Analyst quantifies trends and identifies and measures opportunities to increase net revenue. Assists with source identification and root cause resolution of denials and payment variances, including underpayment analysis and management. This position is responsible for identifying potential charge capture workflow improvements and calculating consistent charge structure methodologies according to industry standards and payer contracts. The RI Analyst will also interpret and manage a variety of metrics and reports, presenting regularly with departments and external stakeholders about operational and technical improvement areas to optimize revenues and ensure integrity and compliance in our charging and billing practices. A high degree of customer service skill is required to establish and improve positive relationships within Revenue Integrity, Revenue Cycle Operations, EIS (IT), Finance, Clinical staff, and other stakeholder departments.
Job Duties and Responsibilities:
Conducts routine charge capture and reconciliation quality control audits. Re-audits workflows and processes if compliance opportunities are identified. Raises instances requiring corrective action to departmental leadership.
Manages and supervises system-wide charge audits process utilizing reporting data and tracking tools. Analyzes audit findings for improvement opportunities, recommends and facilitates process improvements.
Consistently oversees and reviews existing billing workflows, inputs and outputs. Independently works with the appropriate team(s) to adjust processes and systems to mitigate revenue leakages and optimize efficiencies.
Partnering with multiple stakeholders such as PBS, EIS (IT), clinical operations, clinicians and others to track revenue flows and identify improvement opportunities within various charge capture systems to facilitate the accuracy and integrity across revenue-generating departments.
Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for Revenue Cycle and service line leaders; uses denials and revenue data to support findings.
Works independently to manage quarterly and annual fee schedule maintenance work and special projects. Reviews existing and new charges to ensure they accurately reflect services/supplies provided and are consistent with industry standard methodologies. Recommends new codes for fee schedule inclusion based on audit findings, staff requests and code updates.
Collaborates with key constituents in different functional areas to create charge capture/reconciliation and billing reports that meet the organization's requirements and trains individual departments on how to properly generate and monitor such reports.
Uses independent judgment to analyze changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable charging and billing guidelines. Stays apprised of payer and/or regulatory updates and is responsible for communicating changes to leadership and impacted areas. Take the lead in coordinating with EIS (IT) to upload changes timely.
Collaborates with revenue integrity & revenue cycle compliance leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement; may also coordinate or deliver revenue integrity and PBS staff training.
Participate in new business initiatives by researching appropriate billing codes, reimbursement and payer policies. Act as Revenue Cycle Compliance representative to research, approve and facilitate implementation of changes.
Handle the intake and fulfillment of all pricing queries and fee schedule maintenance requests for the medical network.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.