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Job Details

Job Description

The Revenue Integrity Analyst will perform internal quality assessment claim reviews to ensure compliance with federal, payer and internal Revenue Cycle policies to ensure complete, accurate and consistent resolution of claims being held due to edits assigned to Revenue Integrity for resolution, resulting from charging and/or reimbursement and data integrity. The position works to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices. The Revenue Integrity Analyst researches claim data variances, evaluates payer updates and assist in the performance of chart-to-bill audits to produce and maintain timely, accurate and inclusive charge capture coding and billing functions. Works to identify charge issues and recommend solutions. The Revenue Integrity Analyst also coordinates and manages several projects simultaneously, reprioritizing when necessary. Identifies the key types of data extraction necessary to create enhanced reports and enrich the analysis from several systems for the purpose of increasing revenue.

Essential Functions

•Performs on-going quality assessment reviews to ensure accurate completion of accounts being held due to payer edits according to Federal regulations
•Extracts data from specific systems to support audit function
•Analyzes, validates, and researches anomalies and cross-referencing data with other systems
•Communicates and supplies charge capture and charge reconciliation analysis, in addition to trending information to Revenue Integrity Auditor
•Provides data analytics for monthly reporting to Revenue Integrity Department
•Serves as a resource to Revenue Cycle Billing staff and clinical departments for complicated billing cases and reimbursement matters

Educational / Training Requirements

Bachelor's degree in business administration, accounting, management, healthcare administration, nursing or other related degree.

Licensing Requirements

Coding certification (e.g. , CCS, CPC, RHIA, RHIT) or applicable experience is preferred

Experience Requirements

•3 years of experience related to auditing and/or coding is required. Clinical experience is preferred
•In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.
•Understanding of multiple reimbursement systems including IPPS, OPPS and fee schedule
•Strong oral and written communication skills.
•Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint and other web-based applications. May produce complex documents, perform analysis and maintain databases

Work Shift

Worker Sub Type

Employee Entity

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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