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Revenue Integrity Analyst

Company: Zymeda Provider Solutions
Location: Moreno Valley
Posted on: August 4, 2022

Job Description:

Job Description Summary This position is a full-time, goal-oriented, revenue-driven, highly accurate and motivated individual. In collaboration with the Director of Analytics, the Revenue Integrity Analyst is responsible for daily and continuous monitoring of all revenue cycle processes to ensure they are performed accurately, timely, in adherence to all state and federal regulations and in alignment with Zymeda's unwavering commitment to integrity and excellence. The Revenue Integrity Analyst conducts individual internal audit projects as part of the annual internal audit plan. This responsibility includes testing and evaluating controls, determining the cause of deficiencies, and assisting Management with the development of process improvement/remediation plans. Work performed will include coverage of functional and operating units, focusing on financial, IT, healthcare compliance, and operational processes. Essential Duties and Responsibilities include the following: Conducts audits and investigations to ascertain the following: Adequacy of internal control systems Efficiency and effectiveness of processes Reliability and integrity of information Compliance with applicable regulations and with internal policies, procedures, and standards Safeguarding of assets, and Economic and efficient use of resources Assists in developing annual internal audit and performance improvement work plan for RCM functions. Identifies, researches, analyzes, resolves, and monitors RCM and charge capture processes to promote appropriate and consistent billing and coding practices. Gathers, compiles, and analyzes billing and statistical analysis. Periodically assist with performing follow-up reviews to ensure planned corrective actions are implemented and items are closed. Develop effective relationships with Management and promote awareness throughout the organization. Stay abreast of best practices both internally and externally and be a conduit for introducing those practices to the company. Attend training and/or seminars. Provides guidance, communication, and education to multiple levels of personnel on correct billing, coding, and charge capture processes. Assists with special projects related to price increases, special requests from clients, system conversions, or implementation of new RCM tools or systems. Assists in training new staff and coaching existing staff by building or enhancing individual skills or deficiencies. Provide one on one coaching or follow up training to staff as needed. Perform other duties or special projects as required. Supervisory Responsibilities N/A Qualifications 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. Education and/or Experience One year certificate from college or technical school; and 5 years of related experience and/or training; or equivalent combination of education and experience. Language Skills Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Reasoning Ability Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. Computer Skills Required experience with Tableau and/or Power BI; knowledge of EMR/Billing Systems and software such as Lytec, PrimeSuite, Epic, eClinical Works, etc., Advanced Excel Spreadsheet software and Word Processing software. Preferred experience with Tableau and/or Power BI, Alteryx. Familiar with processes established by the Institute of Internal Auditors (IIA), and Robotic Process Automation (RPA) and Artificial Intelligence (AI). Certificates, Licenses, Registrations Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, COC, CPC, CCS highly desirable. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to fingers. The employee is occasionally required to walk; reach with hands and arms and talk or hear. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually quiet.

Keywords: Zymeda Provider Solutions, Moreno Valley , Revenue Integrity Analyst, Professions , Moreno Valley, California

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