Revenue Integrity Analyst

In the role of Revenue Integrity Analyst, you be working in Clinical Practice Services. You will play a key role in providing data-driven insights that enhance billing accuracy, streamline reimbursements, and optimize overall professional patient services revenue. This analytical position requires a detail-oriented professional with a solid background in professional services revenue cycle operations, and a strong command of data analysis. This individual will collaborate closely with revenue cycle operations to support charge reconciliation and denials prevention efforts.

All remote work must be performed within one of the MCW registered payroll states, which currently includes: WI, AZ, FL, IL, IN, MD, MI, MN, MO, NC, TN,TX, and UT.

Responsibilities:

• Consistently monitors charging practices across all locations through charge reconciliation, remediation training and education to coding & charge capture staff and providers.
• Examines accounts, claims, and clinical documentation for charge capture and billing quality and accuracy. Interprets documentation from medical records to validate charges. Provides feedback and education, as appropriate, depending on findings.
• Provides education and training to departments on charge reconciliation reporting; analyzes monthly reporting trends and escalates deficiencies to ensure 100% charge capture.
• In partnership with revenue cycle operations, Epic PB analysts, and clinical department SMEs, reviews, interprets, and implements coding and billing changes impacting assigned clinical specialties/service lines related to the quarterly and annual CPT update process. Evaluates clinical processes to establish what changes are required to accommodate updated coding and billing regulations.
• Collaborates with revenue cycle operations leaders, clinical departments, providers, & Epic analysts in development of charging practices for new service lines or procedures. Monitors charging practices post-implementation to offer targeted guidance and support.
• Identify areas for revenue cycle enhancement, including opportunities for reducing initial denials, improving collection rates, and enhancing billing accuracy, resulting in improved overall revenue capture.
• Analyze claims and denials data, providing insights to revenue cycle teams to reduce denial rates and ensure timely reimbursement.
• Collaborate with revenue cycle and operational teams to streamline processes, reduce inefficiencies, and improve overall cycle times.
• Ensure revenue cycle activities adhere to healthcare regulations and payer requirements, providing recommendations to enhance clean claim rates.
• Continuously track key metrics such as denial rates, avoidable write-offs, and collection efficiency, to support revenue cycle goals and provide actionable insights.
• Participate in projects related to revenue cycle improvements, system upgrades, and process improvement.

Knowledge – Skills – Abilities

Knowledge of payer policies and claims requirements. Ability to understand, interpret, establish impact of and respond to complex instructions from state and federal governing entities. Advanced knowledge of CPT and ICD-10 coding guidelines. Proficient in Epic Professional Billing, Dashboards, Reporting Workbench and Slicer Dicer. Advanced knowledge of Microsoft Office, especially Excel, to include formulas, functions, and pivot tables, to examine large data sets and draw conclusions. Focus on continuous process improvement. Ability to react to frequent changes in duties and volume of work. Effective communication skills and writing capabilities / efficiencies. Ability to manage multiple tasks with ease and efficiency. Effective interpersonal skills, including the ability to promote teamwork, strong problem-solving skills. Ability to execute tasks through an organized and detailed approach.

Preferred Schedule:

Full-time role with expectations for coverage during core business hours and flexibility required as necessary to accommodate business needs.

Position Requirements:

Minimum Qualifications:

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education: Associate’s degree

Minimum Required Experience: Five (5) years of experience in a health care setting, working in professional services coding & charge capture, reimbursement follow-up, or revenue integrity.

Certification: Certified professional coder – (CCS-P, CPC, CPC-A) and/or health information management credential (RHIT or RHIA).

Preferred Qualifications:

Preferred Education: Bachelor’s degree in business, health information management, or related fields.

Preferred Experience: Seven+ (7+) years of coding & charge capture and/or reimbursement follow-up and/or revenue integrity experience in professional revenue cycle operations for large, multispecialty group practices and/or academic medical centers.

Why MCW?

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Pet Insurance
• On campus Fitness Facility, offering onsite classes.
• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.