Revenue Integrity Specialist/Coder (F/T) - Remote

Optim Health is seeking a full time Revenue Integrity Specialist/Coder. This is a Remote position.

Position Summary:

The Revenue Integrity Analyst works with the management team of Revenue Cycle operations to drive business value by supporting revenue cycle management in the analysis of Revenue Cycle data as well as proactive identification of process improvement, charge master compliance and accuracy as well as charge capture opportunities and applying analytical and critical thinking to generate innovative and practical solutions to revenue cycle issues. Through research and analysis, the Revenue Cycle Analyst will assist with establishing benchmarks, and will act as a liaison between functional areas to ensure stakeholders understand and interpret data related to the benchmarks. Additionally, this position will assist in leading discussions regarding the data for the administrative, legal, operational, and financial opportunities for Revenue Cycle areas.

 Essential Functions and Responsibilities Includes the Following:
 1. Understands and adheres to the Optim Health Performance Standards, Policies and Behaviors.
 2. Assures the delivery of quality department /clinical services in accordance with established hospital and regulatory/accreditation agency standards.
 3. Is responsible and accountable for the overall compliance of their assigned department.
 4. Assures employee compliance with hospital and Human Resources policies and procedures as well government regulations and guidelines.
 5. Assures competency and education requirements are satisfied as per hospital policy.
 6. As required participates in the Performance Improvement Program as defined by the organization
 7. Is responsible for participation in committees, task forces and projects as appropriate.
 8. Assures the provision of a safe employee/patient environment.
 9. Maintains knowledge related to the operations of their department. 
 10. Works collaboratively with all levels of the hospital interdisciplinary team and promotes the team concept within their department and hospital wide.
 11. Demonstrates positive customer service, fosters positive employee relations and assures that staff adhere to the Customer Service Behavioral Standards.
 12. Is supportive of hospital initiatives and projects and functions as a positive change agent.
 13. Promotes a positive and professional image and is a role model, coach, mentor and resource for staff and peers.
 14. Ensures compliance with all regulatory standards and policies.
 15. Responsible for research and roll-out of federal and state updates pertaining to hospital and billing compliance
 16. Works to protect revenue based upon regulatory compliance requirements.
 17. Responsible for analysis of audit findings to report to senior management findings and recommendations to prevent future loss as well as protect current revenue.
 18. Educates staff and other departments regarding federal and state laws as it pertains to hospital procedures and billing guidelines.
 19. Disseminate government updates to healthcare providers, ensuring necessary changes are made to processes, charge master, and/or billing process as required within the time frame for accurate and compliant billing.
 20. Works independently managing time lines, projects and audits to ensure compliance within required time frames and go live dates.
 21. Responsible for hospital enrollment and revalidation of government agencies.
 22. Handles billing office reporting to government agencies as required.
 23. Manages audits both external and internal as it pertains to the billing office.
 24. Responsible for communicating findings and overseeing corrective actions for audits within the operational units.
 25. Responsible for upkeep of the charge master and ensuring the compliance and integrity of the charges and billing.
 26. Performs charge master integrity audits as well as charge audits to ensure all revenue is captured appropriately at the account level and in the billing system.
 27. Reviews billing edits to ensure accurate and complete billing following regulatory requirements, to resolve and prevent future edits.
 28. Attends and participates in educational programs or activities to maintain current level of knowledge or expertise.
 29. Insure proper billing protocols and guidelines are followed.
 30. Works in conjunction with members of the management team and departments to respond to audits as well ensure compliance with state and federal regulations.
 31. Develops and implements policies and procedures to insure compliance with all regulatory agencies.
 32. Attends Management/Leadership meetings as required.
 33. Utilizes multiple methodologies to communicate information.
 34. Adheres to safety standards for employees and patients.
 35. Interacts with hospital ancillary revenue departments, patient registration, and case management to ensure compliant practices and streamline revenue.
 36. Participates in committees, task forces, projects, etc. as required.
 37. Submits all other work reports as required/requested by the Division Administrator.
 38. Designs, implements and maintains procedure manuals for all areas of responsibility.
 39. Performs all other related duties as assigned