Revenue Integrity Analyst

SHIFT:

Seeking Breakthrough Makers

Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview

The Revenue Integrity Analyst plays a pivotal role in ensuring accurate charge capture, billing and reimbursement across our revenue cycle. You'll collaborate closely with the Revenue Integrity Specialist (RIS), Revenue Integrity Auditors, and the CDM team - and serve as the key liaison between the RIS and their assigned clinical departments. In this visible, impactful role you'll help improve internal processes and policies turning them into practical, compliant workflows that optimize reimbursement and reduce denial risk. Ideal candidates are skilled at building productive relationships across departments. If you enjoy problem-solving, cross-functional collaboration, and making a measurable difference in revenue operations, this is an exciting opportunity to grow your career in a mission-driven organization.

Apply today and help strengthen the financial health of our hospital system-while enjoying the flexibility of a fully remote role.

What you will do

• Focus on review, correction, trending and prevention of denials within Revenue Integrity's control

• Review, identify, analyze EPIC work queues, reports and claim data to identify root cause of denials

• Works with the RI Specialist and their revenue producing departments to help minimize charge capture methods that may be contributing to denials by analyzing trends in payments and denials, identifying discrepancies, and collaborating with them to resolve issues, prevent revenue leakage

• Perform applicable analyses to understand net revenue effect of any proposed charge capture changes.

• Perform internal billing audits to ensure correcting coding/billing regulatory compliance and charge capture accuracy.

• Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims. Assists in researching coding issues and recommends solution to account representative. Identifies source of problem and works with analysts to implement corrective actions to ensure that the charge capture is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement

• Assist in strategic pricing process to optimize reimbursement within budget guidelines.

• Participate in ongoing coordination and resolution of revenue issues as they arise.

• Assists in troubleshooting and resolving issues related to the patient revenue cycle, and assists in development and recommendations.

• Performs other duties as assigned.

Education Qualifications

• Associate's Degree Business, Healthcare or related field Required
• Bachelor's Degree Business, Healthcare or related field Preferred

Experience Qualifications

• At least three (3) years Hospital or physician revenue cycle, billing, or coding Required
• At least five (5) years Experience with coding, billing and CDM maintenance Preferred

Skills and Abilities

• Business Skills: Knowledge of healthcare revenue cycle functions, and billing and collection processes specific to the charge master. (Required proficiency)
• Regulatory: Knowledge of CMS local, state, and federal regulatory and the various data elements associated with all types of claim forms. (Required proficiency)
• Business Analytics: Identifies data and analytic challenges including data integrity, appropriateness of data sample, context and consistency between sources. Fully leverages power of analytic tools (Required proficiency)
• Collaboration: Experience supporting RI initiatives specific to implementation, and/or major process improvement and redesign. (Required proficiency)
• Facilitator: Plans effectively yet is fluid based on the atmosphere and needs of the audience. Connects with the group. Is masterful and an engaging listener. Experience with coding, billing and CDM maintenance (Required proficiency)

Licenses and Certifications

• Certified Outpatient Coder (CPC-H) - American Academy of Professional Coders (AAPC) - within 12 months - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.