LCMC Health

Charge Integrity Analyst – Revenue Integrity

LCMC Health

full-time

Posted on:

Location Type: Remote

Location: Alabama • Florida • United States

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About the role

  • Collaborate with Charge review Coordinators and Charge Review Specialist to monitor charge capture functions across all LCMC entities.
  • Conducts thorough reviews of patient charges to ensure services provided are accurately captured and billed.
  • Verify the correct usage of procedure codes (CPT/HCPCS) and diagnosis codes (ICD-10) to ensure charges align with clinical documentation.
  • Identify and investigate charge discrepancies, missing charges, or incorrect coding, and work with relevant departments to resolve issues.
  • Serve as a resource for charge integrity specialists and departments on charge-related inquiries, providing support and guidance on proper charge capture practices.
  • Provide feedback and training to clinical departments on charge capture issues and regulatory changes that impact billing and coding with oversight by the charge review coordinator.
  • Educate on best practices for documentation and charge entry to enhance revenue capture and compliance.
  • Prepare and present reports on charge review findings, highlighting areas of improvement and compliance risks.
  • Monitor key performance indicators (KPIs) related to charge capture accuracy and timeliness.
  • Create action plans when KPI’s are above target.
  • Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements.
  • Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
  • Monitors EPIC Revenue Integrity Dashboard(s) and Ri assigned work queues to assist in completion and timeliness of completion meeting Revenue Integrity Department standards.
  • Provide support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity.
  • Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, charge capture navigators, and other charge components.
  • Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.
  • Train and assist in daily resolution of revenue integrity edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation.
  • Performs miscellaneous duties as assigned.
  • Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes.
  • Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders.
  • Excellent organizational and project management skills.
  • Strong time management, attention to detail, and follow through.
  • Well-developed research skills.
  • Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively.
  • Work effectively as a team contributor on all assignments.
  • Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
  • Delivers positive patient experience, where applicable.

Requirements

  • Minimum: 3 years' experience in the hospital setting, healthcare industry, revenue cycle or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management.
  • Preferred: EPIC HB/PB experience
  • Minimum: High school diploma or GED with equivalent combination of certification and experience is required.
  • Preferred: Associate’s degree in healthcare administration, Health Information or related field is preferred.
  • Applicable professional certification through AHIMA (RHIA, RHIT, CCS), RN, LPN or AAPC (COC, CPC) or Epic Certified.
  • Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500.
  • Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10.
  • Advanced knowledge of NCCI edits, and Medicare LCD/NCDs.
  • Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care.
  • Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
Benefits
  • Deliver healthcare with heart.
  • Give people a reason to smile.
  • Put a little love in your work.
  • Be honest and real, but with compassion.
  • Bring some lagniappe into everything you do.
  • Forget one-size-fits-all, think one-of-a-kind care.
  • See opportunities, not problems – it’s all about perspective.
  • Cheerlead ideas, differences, and each other.
  • Love what makes you, you - because we do You are welcome here.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
charge captureprocedure codesCPTHCPCSdiagnosis codesICD-10charge reconciliationcharge compliancecharge auditingCDM management
Soft Skills
organizational skillsproject managementtime managementattention to detailresearch skillscommunication skillsteam collaborationindependent workpresentation skillscustomer interaction
Certifications
RHIARHITCCSRNLPNCOCCPCEpic Certified