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CHRISTUS Southern New Mexico is strong on charging and capturing the services rendered by our healthcare workers in that we provide quality healthcare. The purpose of the Revenue Integrity Analyst is to review the medical records to review the services rendered, and to ensure we have charges to capture our billable services. Where the analyst finds departments struggling, is where the analyst finds opportunity to work with the department, and educate them with proper guidelines on how to capture their work, to ensure their department is capturing its overall value for their services.
Responsibilities:
Demonstrates knowledge and skills necessary to provide services based on the physical, psychosocial, educational, safety, and other related criteria appropriate population in his/her assigned area
Maintains required core competencies.
Complies with set Policies and Procedures (i.e. name tag, dress code, parking, smoking, etc.)
Analyzes department charges for discrepancies, and provides immediate resolution in order to keep the Billing Cycle flowing.
Works with Patient Accounts department to resolve any claim edits, and provides resolution based off of CMS Guidelines, so that the billing stays compliant.
Reports any identified chargemaster related discrepancies to the Director of Revenue Integrity
Reviews claims for any missed procedures, supplies, or medication charging
Performs routine audits over assigned departments to identify any routine issues that can cause for revenue leakage.
Any additional duties as assigned that are related to the operations of the Revenue Cycle and Billing.
COMMUNICATION AND INTERPERSONAL EXPECTATIONS:
Demonstrates communication skills necessary to interact with persons of varying age and/or cultures.
Answers telephone as assigned, routes calls or takes messages appropriately.
Supports the Mission and Philosophy of the hospital and the Department. Demonstrates an understanding and application of these policies.
Respects confidentiality.
QUALITY IMPROVEMENT I LEGAL COMPLIANCE: A. Quality Improvement
Participates in hospital quality activities as required.
Participates in department quality activities as required.
The employee will adhere to organizational/-departmental customer service standards.
Demonstrates understanding of Legal Compliance issues and their responsibilities for same.
Participates in yearly legal compliance training.
Explains departmental chain of command.
Explains purpose of Legal Compliance Hotline and utilizes if indicated.
Participates in departmental Legal Compliance plan.
Attended Orientation/Re-Orientation
Completed Annual Department Competencies
Requirements:
Education
High School diploma or equivalent.
Experience
Performs related responsibilities as assigned.
Licenses, Registrations, or Certifications
Current American Heart ? Basic Life Support (BLS) card.
Certification for coding or auditing from the AAPC, AHIMA, or AAHAM companies is preferred, but not a must.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.
