Revenue Integrity Analyst I - Remote

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

JOB SUMMARY

This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle. This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or federal). Position requires a working knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes and any appropriate modifiers, various payment methodologies, as well as working knowledge of appropriate, compliant hospital and provider billing and charging practices. This position provides key insights garnered from essential duties and responsibilities to their supervisor and/or manager assisting in proactively identifying areas of opportunity to prevent future edits, rejections, and/or denials of similar nature and improve clean claim rates, prevent revenue leakage, and reduce overall denials. Responsible for fostering and maintaining strong, collaborative relationships with all levels of staff both internally as well with the facilities, partners, and/or clients we serve including clinical teams and hospital departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Identifies, tracks, and reviews revenue cycle held claim edits, rejections, and/or denials including verifying legal health record documentation to identify appropriate resolution and/or preventative solution to the identified claim/billing edits, errors, omissions, rejections, and/or denials including correcting and resubmitting the claim. This may include data quality reviews on codes and/or charges as well as addressing NCCI (national correct coding initiative), OCE (outpatient code editor), NCD (national coverage determination), and LCD (local coverage determination) edits as appropriate to the edit, rejection, and/or denial worked. Verifies all worked claims are to the payer within timely filing limits.
• Identifies, tracks, and monitors any revisions and/or corrections they make to the claims processing system and/or CDM to ensure corrections occur in a timely manner. In-depth critical thinking, research, and analysis is required. Strong working knowledge of HCPCS, CPT codes, modifiers, charging, and payment methodologies are essential.
• Identifying and assisting with root cause analysis of revenue cycle edits and/or denials that negatively impact operations including assisting and collaborating in the development of enterprise-wide solutions to prevent future recurrence.
• May assist in training and/or education related to new staff, department staff, and client after experience and competence has been documented.
• Establishing, fostering, and maintaining strong, collaborative relationships with all levels of staff both internally as well with the facilities, partners, and/or clients we serve including clinical teams and hospital departments.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Working knowledge of the principles, practices and tools relating to accounting, financial management, reimbursement, and general healthcare billing.
• Ability to understand and effectively complete report creation, audit techniques, spreadsheet presentations.
• Ability to convince others and persuade to timely action based on regulations, risk exposure level, compliance deficiencies and audit findings.
• Ability to establish and maintain effective working relationships as required by the duties of the position.
• Working knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority.
• Working knowledge of medical terminology and health care nomenclature, systems, HIM coding and general billing/reimbursement practices.
• Ability to convey technical information effectively in verbal and written communications, and in group/business presentations.
• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency, including Excel.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Entry Level: Experience Preferred
• High School graduate or equivalent required
• College degree preferred
• Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, COC, CPC, CCS highly desirable

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel*
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments*
• May require these demands

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment
• Hospital Work Environmen

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.