Houston, Texas

JOB SUMMARY

At Houston Methodist, the Revenue Integrity Analyst position is responsible for charge capture and denial management monitoring activities related to physician revenue cycle initiatives. This position coordinates and monitors charge reconciliation processes throughout the Houston Methodist Physician Organization (PO) and works directly with departmental stakeholders to implement and manage charge reconciliation processes on the front end. The Revenue Integrity Analyst is responsible for ongoing electronic medical record maintenance as it relates to physician fee schedules, including fee requests and build, and works directly with PO finance and IT teams to monitor fee schedule activity. This position analyzes and prepares reporting on relevant denial trends, determines root causes of denials, and works with the appropriate departments to establish processes to ensure prevention of the denials. The Revenue Integrity Analyst also develops, produces, and validates standard management and ad-hoc reports as requested by end-users.

PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 20%

  1. Coordinates with the front end clinical operations team to implement charge reconciliation processes. (EF)
  2. Works directly with the revenue cycle coding team to complete charge reconciliation. (EF)
  3. Communicates with the front end clinical operations team to determine root causes of significant charge fluctuations. Works directly with the clinical operations team on charge capture workflows. (EF)

SERVICE - 25%

  1. Provides quality assurance, direction and guidance to PO departments. (EF)
  2. Develops and implements tools to monitor and identify significant fluctuations in charge volumes and reports these fluctuations and root causes to the revenue cycle and clinical operations leadership team(s) as appropriate. (EF)
  3. Develops and implements charge reconciliation processes and tools for the clinical operations team to effectively use on the front end. (EF)

QUALITY/SAFETY - 20%

  1. Monitors for charge capture issues, identifies the root cause and develops updated workflow documentation and training to prevent the issue from happening in the future. (EF)
  2. Develops and completes annual revenue integrity reviews for the PO. Coordinates annual Current Procedural Terminology (CPT) updates summaries for distribution to the impacted departments. (EF)
  3. Maintains strict confidentiality of patients, employees and hospital information at all times. Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations. (EF)

FINANCE - 20%

  1. Maintains current and accurate physician fee schedules. (EF)
  2. Monitors for trends and identification of missed revenue opportunities and areas for potential revenue enhancement. (EF)
  3. Reviews denials and payor rejections based on various denial reasons, identifying root causes and formulating process improvement initiative to prevent future denials. (EF)

GROWTH/INNOVATION - 15%

  1. Assists in establishing consistency across practices as changes in processes, tools, and overall practices are developed. (EF)
  2. Designs and presents work aids or reference materials to aid in consistency across the organization as it relates to revenue cycle charge capture functions. (EF)

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION REQUIREMENTS

o Associate’s degree

EXPERIENCE REQUIREMENTS

o Five years of experience in professional revenue cycle

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED

o Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA), or an approved Specialty Society Coding Certification

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

o Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

o Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

o Proficiency in Microsoft Office applications with advanced skill in Excel

o Understanding of CPT, International Classification of Diseases 9th Revision (ICD-9), and International Classification of Diseases 10th Revision (ICD-10) coding

o Knowledge of medical billing practices

o Knowledge of insurance requirements for physician visits and procedures

o Ability to multi-task in a fast paced environment, prioritize projects and work independently with attention to detail

o Demonstrates a high level of professionalism, customer service and interpersonal skills

o Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner

o Ability to think critically and identify the global impact across the revenue cycle with a solution oriented approach

 

 

SUPPLEMENTAL REQUIREMENTS

Work Attire Yes/No

Uniform No

Scrubs No

Business professional Yes

Other (dept approved) No

 

On-Call* No

 

*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.

 

Travel**

May require travel within Yes

Houston Metropolitan area

 

May require travel outside No

of Houston Metropolitan area

 

**Travel specifications may vary by department.

 

Please note any other special considerations to this job: __________________________

Company Profile:

As one of the nation’s leading hospitals and academic medical centers, Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. Houston Methodist Specialty Physician Group employs over 800 physicians at more than 150 locations across Houston. Our specialists are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. The combination of clinical service, research and academics ensure patients have access to the latest treatments and technologies while providing the best comprehensive patient care.

Houston, Texas

At Houston Methodist, Leading Medicine is more than a description of what we do; it's who we are. We take our responsibility as Houston's premier health care system seriously, and with a national reputation for excellence in patient care, innovation and research, we hold ourselves and the careers we build to a higher standard. Our culture is diverse, dynamic and challenging. We believe in our I Care Values and conduct ourselves with Integrity, Compassion, Accountability, Respect for others and a commitment to Excellence. Discover the difference for yourself and join Houston Methodist.

You can click on the video links below to learn more!

·  About Houston Methodisthttps://www.youtube.com/watch?v=ClN3mmKT0EI

·  Nursing at Houston Methodisthttps://www.youtube.com/watch?v=EUfmVeansTo

·  Houston - Best City to Live Inhttps://www.youtube.com/watch?v=MzLQzGBjHJw