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Houston Methodist Revenue Integrity Analyst- Central Building Office-Telecommute in 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.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED

Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

  • Provide personalized care and service by consistently demonstrating our I CARE values:

  • INTEGRITY: We are honest and ethical in all we say and do.

  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.

  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.

  • RESPECT: We treat every individual as a person of worth, dignity, and value.

  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

  • Focuses on patient/customer safety

  • Delivers personalized service using HM Service Standards

  • Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

  • Intentionally rounds with patients/customers to ensure their needs are being met

  • Involves patients (customers) in shift/handoff reports byenabling their participation in their plan of care as applicable to the given job

  • Displays cultural humility, diversity, equity and inclusion principles

  • Actively supports the organization vision, fulfills the mission and abides by the I CARE values

PRIMARY JOB RESPONSIBILITIES

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

PEOPLE - 20%

  • Coordinates with the front end clinical operations team to implement charge reconciliation processes. (EF)

  • Works directly with the revenue cycle coding team to complete charge reconciliation. (EF)

  • 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%

  • Provides quality assurance, direction and guidance to PO departments. (EF)

  • 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)

  • Develops and implements charge reconciliation processes and tools for the clinical operations team to effectively use on the front end. (EF)

QUALITY/SAFETY - 20%

  • 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)

  • 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)

  • 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%

  • Maintains current and accurate physician fee schedules. (EF)

  • Monitors for trends and identification of missed revenue opportunities and areas for potential revenue enhancement. (EF)

  • 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%

  • Assists in establishing consistency across practices as changes in processes, tools, and overall practices are developed. (EF)

  • 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: ________

Houston Methodist Specialty Physician Group - 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. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.

Street: N/A

Name: EPIC-Coding&Revenue Integrity

Regular Shift: 1st - Day

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