SUMMARY: Revenue Integrity (RI) Charge Capture Analyst is responsible for providing assistance in maintaining systems, processes and work flows, for the timely and accurate recording of hospital revenue in regards to charge capture. This position supports the clinical charging manager and serves as a facility liaison to the Alameda Health System (AHS) staff as it relates to charge capture/billing concerns. The analyst will assist in upholding AHS administrative and fiscal excellence within Revenue Cycle by providing expertise to assist and educate appropriate staff on charging efficiencies, ensuring payment integrity and the accuracy of charging practices. The RI Charge Analyst is responsible for reviewing the charges for all designated services provided in various settings including the emergency department, observation care, and infusion centers in compliance with AHS policies.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
1. Assists with report findings from the assigned work queues, erroneous or missing charge postings with following up analysis, development, and implementation of recommendations and actions plans to minimize late or missing charges.
2. Completes a review of observation time and the necessary carve out of observation hours based on CMS and AHS guidelines and works closely with IT to ensure carve out of hours are working as designed.
3. Daily review of all accounts work queue. Reviews the documentation in the medical record for appropriate documentation to support charges and aligned with CPT correct coding initiative rules.
4. Ensures the appropriate bundling or unbundling of charges, and applicable modifiers applied so that all charges that are submitted result in optimal reimbursement while following applicable billing, coding and reimbursement regulations within respective areas and informs charge master analysts, PFS teams, etc. of any errors identified
5. Maintain working knowledge of CPT and HCPCS coding.
6. Makes necessary charge corrections according to AHS policies and payer rules and maintains number of outstanding accounts in WQ to within 3 days of service.
7. Partners with Sr. RI Analysts in clinical revenue manager engagements when charge capture opportunities are identified.
8. Performs manual charge entry when possible missing charges identified.
9. Performs other duties as assigned by management.
10. Reviews and generates accurate and timely charges for services provided in the outpatient setting including the emergency departments, observation, infusion centers and any other areas that may be assigned.
11. Runs assigned reconciliation reports (e.g. Revenue Reconciliation Monitoring Reports, Encounter Charge Reconciliation Reports, etc.) as assigned, that will be used to identify charge related opportunities.
12. Work closely with individual facilities representatives/clinical staff as assigned to establish and maintain positive relations to ensure charge capture goals are achieved.
13. Works daily work queues to resolve bill holds for charge related issues assigned to the revenue integrity Charge Capture unit in the charge review Revenue Guardian and, DNB work queues.
14. Works with the Senior Revenue Integrity Analysts to document and report findings and work with education team to develop recommendations and corrective actions.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Minimum Experience: Three years accounting, facility billing, patient accounting or business office experience preferred or three years acute care hospital experience or working in a Clinic/Outpatient setting.
Preferred Education: Bachelor's degree in a clinical health-care related field.
Required Education: High School Diploma or G.E.D.
Required Licenses/Certifications: Certification as a medical coder through AHIMA (CCS, CCS P) or through AAPC (CPC, COC, CIC) and/or certification as a Revenue Cycle Integrity Professional (CRIP). Certification needed within 1 year of date of hire.