Revenue Assurance Analyst II

Position Summary / Career Interest:

Works with Director and Assistant Director of Revenue Assurance, Audit, and Advisory Services to develop, perform reviews, provide and communicate recommendations and education to department leadership and providers as determined by audit findings. Assists Director and Assistant Director in performing federal and state regulatory research, making presentations to internal and external audiences, and providing education to departments on federal and state compliance requirements as well as contracted commercial payer guidelines.


Responsibilities and Essential Job Functions

• Conduct regular and comprehensive audits to assess the effectiveness and accuracy of internal controls, financial records, and compliance with laws, regulations and the health system's policies and procedures.
• Identify compliance issues, assess risks, and recommend solutions to resolve the issues.
• Analyze and prepare reports on audit findings to include recommendations provided to leadership and providers to enhance the compliance with health system's policies and procedures and mitigate risk.
• Keep updated on new laws and regulations that may affect the health system's operation and its internal policies.
• Perform high risk/high dollar audits of clinical, operational, and financial processes to ensure compliance with government regulations, health system and payor policies and billing accuracy.
• Facilitates high risk/high dollar external government and commercial payer audits by tracking audits, responding to requests for documentation, responding to audit results to include appeals of denials.
• Review and educate HIM coding and billing staff as necessary (i.e. Peer Review, coding and billing rules).
• Demonstrate competence in the areas of critical thinking, interpersonal relationships, and technical skills.
• Prepare clear, concise audit workpapers.
• Mentor providers and clinical staff on billing and coding compliance.
• Follow up with auditees to ensure management responses are received timely and to determine the implementation status of recommendations
• Serves as a resource in addressing compliance queries from Medicare, Medicaid, other third parties, internal legal counsel, Hospital Executive office or other staff/ interested party.
• Serve as a billing guidance resource for HIM coding and billing staff.
• Conduct meetings with health system leadership and clinicians to review findings and recommendations.
• Utilize audit procedures and other analytical tools to meet objectives determined for completion of special projects.
• Perform the professional, clinical and or technical competencies of the assigned unit or department.
• Research commercial contract requirements and reimbursement logic.
• Participate as a consultant in Revenue Cycle / HITS Workgroups with subject matter expertise.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Associates Degree OR
• High School Graduate 7 or more years of experience in healthcare compliance related audit field
• 5 or more years medical chart auditing, claims and billing, coding or applicable experience

Preferred Education and Experience

• Bachelors Degree

Required Licensure and Certification

• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) OR
• Certified Public Accountant (CPA) - State Board of Accountancy OR
• Registered Health Information Administrator(RHIA) - American Health Information Management Association (AHIMA) OR
• Registered Nurse OR
• Certified Health Care Compliance - Compliance Certification Board OR
• Other applicable certifications including Epic Proficiency or Certifications

Knowledge Requirements

• Proficient knowledge of medical terminology, ICD-10 and CPT codes
• Knowledge of Medicare, Medicaid, and other federal/state compliance guidelines
• Excellent communication skills
• Coding knowledge

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.