Revenue Integrity Analyst

About the Role

The Revenue Integrity Analyst manages projects and service lines, ensuring system-wide charge capture activities align with Baylor Scott & White Health (BSWH) processes, policies, and State and Federal guidelines. This role involves developing and maintaining in-depth knowledge of assigned primary service lines and key relationships, acting as a representative for service lines, Revenue Integrity, and the broader Revenue Cycle to individuals and leadership.

Key Responsibilities

• Create standardized charging methods for all facilities within assigned service lines.
• Partner with IS to design, build, validate, and test workflows impacting the Revenue Cycle.
• Develop a thorough understanding of charge capture workflow and mechanisms to assist IS teams in building necessary systems.
• Manage charge capture projects and initiatives for assigned service lines.
• Identify problems by evaluating business requirements and analyzing data.
• Negotiate organizational consensus and synthesize key messages for stakeholder communication.
• Collaborate with multiple teams to support charging and billing accuracy.
• Perform charge capture audits and education, designing and conducting audits to evaluate compliance with BSWH policies, procedures, and laws.
• Formulate recommendations and corrective actions based on audit findings.
• Compile written audit reports detailing risks, financial impacts of deficiencies, and propose mitigation solutions.
• Independently manage responsibilities within established guidelines, exercising sound judgment and escalating complex issues.
• Examine accounts, claims, and clinical documentation for accurate charge capture and billing.
• Interpret medical records to validate charges and provide feedback and education.
• Ensure the accuracy of the Charge Description Master (CDM), evaluating critical data elements and adherence to CMS, AMA, third-party payor, and other guidelines.
• Validate all CDM changes for data integrity.
• Review, interpret, and implement coding and billing changes for assigned service lines related to CPT updates.
• Evaluate clinical processes to determine necessary changes for updated coding and billing regulations.
• Provide charge reconciliation education to assigned service lines and clinical departments, performing frequent audits for compliance.
• Assist new departments, facilities, services, workflows, or methodologies with charge capture audits.
• Round with department leadership and stakeholders to ensure operational success and provide an avenue for questions and escalations.
• Perform other appropriate duties as required in a competent, professional, and courteous manner.

Requirements & Tech Stack

• Advanced Excel knowledge, including formulas, functions, and pivot tables.
• Epic Hospital Billing, Professional Billing, and Chargemaster experience preferred.

Qualifications

• EDUCATION: Bachelor's degree or 4 years of work experience above the minimum qualification.
• EXPERIENCE: Less than 1 Year of Experience.
• Possess exceptional verbal and written communication skills.
• Ability to create informative, concise communications free of spelling and grammatical errors.
• Experience managing projects preferred.
• Ability to execute tasks through an organized and detailed approach.
• Ability to work independently and as part of a team in a fast-paced, unpredictable, and deadline-driven environment.
• Exceptional organizational skills.
• Proficiency in researching complex questions and providing recommendations.
• Self-motivated with the ability to identify and resolve issues and advance personal knowledge.
• Ability to interpret complex state and federal regulatory requirements, assess their impact on billing, reimbursement, and compliance, and take appropriate action to support accurate and compliant revenue cycle processes.