Revenue Integrity Analyst Ii

Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
Revenue Integrity Analyst is responsible for quality control and implementing the reimbursement functions at the Driscoll Children's Hospitals in order to complete Supplemental programs, payer policy changes, determine the impact of federal regulations on hospital operations and maintain proper account analysis. This position is also responsible for review of third party accounts for all Driscoll facilities; preparation of charge master forecasts, payer policy changes, Medicaid and Medicare programs. As the Revenue Cycle Analyst, this position is also responsible for assisting the Manager and Director as necessary.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Maintain utmost level of confidentiality at all times.
• Adhere to hospital policies and procedures.
• Management of Alternative Payment Programs, Payer Incentive Programs and Directed Payment Programs.
• Track the Payment Methodology and Mechanics of these Supplemental Programs (noted above)
• Analysis any changes to the Charge Master (on a per audit, annual, quarterly, etc. basis.) as it relates to Budget, New Service Lines and Audits
• Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Assist in gathering data required of outside audit staff for MCR and MCD and reports on audits adjustments to management.
• Meet with Clinical Directors and other Leadership to discuss review of Charges based on Yearly changes, Audits or New Service lines/Locations
• Assist in analysis and interpretation of rules and regulations and ensure data is in the format required for reporting purposes
• Responsible for timely research and evaluation of Medicaid laws and changes to be incorporated in the departments and or organization's policies and procedures to optimize reimbursement
• Comply and keep up-to-date all communications related to MCD and MCR guidelines, rates and developments
• Gather, prepare and ensure timely submission of various state joint annual reports and/or compliance reporting.
• Prepare analytical reports on trends in health care reimbursement services and advise on these sources, such as insurance and third party fund sources.
• Assist in the analysis of proposed or new changes in legislation that would affect hospital funding and operating service lines
• Perform extensive data mining and testing of financial and clinical information from various decision support tools and software's, as needed, for effective and accurate department reporting.
• Assist in the performance of special reviews at the request of Revenue Cycle Director.
• Assist in the design and improve reimbursement models and cost report formats.
• Maintains a sense of professional and self-validation.
• Other duties as assigned.

Education and/or Experience:

• Bachelor's degree in Healthcare/Business Management or Accounting (or equivalent in education and experience)
• Understand how to research rules and regulations that govern Medicare and Medicaid reimbursement
• Proficiency in Microsoft Excel, PowerPoint and Word
• Prior experience with EPIC, 3M, ICD-10 or Midas is a plus
• 3+ years of experience in a hospital or healthcare setting