Revenue Integrity Analyst II - Contract Maintenance Analyst - Revenue Integrity

It takes a lot of very smart, hard-working and talented people to provide the level of care that we give to our patients. Tufts Medical Center is an internationally respected academic medical center and we pride ourselves not only on the sophistication of the care we deliver, but the compassionate way in which we provide it. And that starts with our employees.

As part of the revenue integrity department, the Revenue Integrity Analyst is responsible for performing and reviewing regular audits to support the maintenance and enhancement of Tufts Medical Center, Physician Organization and Floating Hospital for Children’s (Tufts) 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 may also be involved in the design and implementation of proper data extraction and analytics processes across departments and service lines.

This position maximizes charge efficiency through: (1) Monitoring revenue cycle processes and staff functions; (2) Supporting Tufts 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:

• Coordinates the hospital charge audit process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities
• Arranges audit timelines with individual departments and external business partners, and ensures each party meets set deadlines
• Conducts routine quality control audits of random sample cases; reports practices requiring corrective action to departmental leadership
• Reviews billing workflows and works with the appropriate teams to adjust billing systems to better catch errors and/or omissions
• Assists in overseeing Tufts charge capture system to promote its accuracy and integrity across revenue-generating departments
• Prepares departmental summaries that pinpoint root causes of charge/billing errors and conceptualize process changes for service line leaders; uses hospital denials data to support findings
• May revisit departments and conduct further audits to gauge the efficacy of charge capture and other process flow recommendations
• Collaborates with key constituents in different functional areas to create charge and billing reports that meet the organization’s requirements and trains individual departments on how to properly generate such reports
• Participates in chargemaster (CDM) maintenance efforts by reviewing whether charges accurately reflect provided services/supplies and are consistent with industry best practices
• Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable charging and billing guidelines
• Recommends new categories for CDM inclusion based on audit findings and solicited staff suggestions
• Fine-tunes and maintains current charge capture methodologies and tools with the finance department
• Summarizes health system-wide charge audit findings to executive staff, finance team, and/or the compliance committee in efforts to ensure all charges are properly captured and reimbursed
• Collaborates with revenue integrity leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement; may coordinate revenue integrity staff training
• Networks with revenue integrity leaders from other organizations to ensure organizational performance is reflective of general industry trends
• Maintains knowledge of and adherence to code of conduct standards, confidentiality agreements, and Tufts values
   

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:

• In-depth knowledge of compliance regulations as they relate to documentation, coding, and billing requirements
• Thorough understanding of revenue integrity processes and their impact throughout the revenue cycle
• Adept analytical skills, and a proven ability to develop effective solutions for complex business challenges
• Strong leadership skills; able to work both independently and as part of a team
• Comprehensive understanding of Microsoft Office products
• Exceptional verbal, interpersonal, and written communication skills
• Effective at adjusting to change, prioritizing duties, and handling stress

EDUCATION:

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

EXPERIENCE:

• Seven 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 is a plus.

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.