• Employment Type: Full Time
• Shift: Days
• Location: Boston, MA

As part of the revenue integrity department, the Revenue Integrity Analyst collaborates to support the maintenance and enhancement ofWellforce charge capture and overall billing functions. In addition, this position will explore potential charge capture workflow enhancements, consistent charge structure and rate setting according to industry standards and payer contracts, and denial trends. This role will also support Epic implementation and analytic processes across departments and service lines.
This position maximizes charge efficiency through: (1) Monitoring revenue cycle processes; (2) Supporting Wellforce revenue capture and integrity through evaluating the accuracy of charge capture and billing functions and staying apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of charge capture/billing workflow improvements.
Under general direction, the Revenue Integrity Analyst identifies revenue and reimbursement opportunities while maintaining compliance with state, local and federal regulations.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• 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 and 1500 billing requirements.
• 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.
• Liaison between clinical areas, Finance, and Revenue Cycle Management on pricing for new Products/services.
• 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 Wellforce revenue cycle committees and related work groups.
• Prepares agendas, minutes and supporting materials for charge master related meetings.
• Provide input for revenue cycle process improvement initiatives.
• Operationalizes key reimbursement information from Third party Contracts for medical and professional services provided by Wellforce.
• Maintain extensive knowledge of ICD-10-CM, CPT/HCPCs procedure coding along with UB-04 and 1500 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.
• Serve as a key resource for financial information and reporting and partners with leadership to identify strategies to affect change.
• Analyzes reports to identify aged or problem accounts.
• Provide continuous quality control through variance checks, analysis and troubleshooting plus detailed research.
• Able to manage large projects with minimal oversight.
• Ad hoc reporting as requested
• Other duties as assigned after appropriate training

AGE SPECIFIC COMPETENCIES:

Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process. This includes:

• Knowledge of growth and development
• Ability to interpret age specific data and response to care
• Provide age specific communication

JOB KNOWLEDGE AND SKILLS:

• Proficiencies: Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs and 1500. 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.
• Epic EAP configuration and build experience.
• Ability to project manage small to medium projects

EDUCATION:

• Bachelors degree from a recognized college or university in business, healthcare or a closely related field required

EXPERIENCE:

• Ten or more years of experience within the revenue cycle. Experience above minimum requirement may be considered in lieu of education.

LICENSES, ETC.:

• CPC, CCS, CHRI, CRCR, Epic Revenue Integrity/Chargemaster certification
  

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.