Full Time
301B Route 1
Professional - Nonclinical
Day Shift
* Position Summary
* Fully remote position
This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between practices and charge improvement process. It is a holistic approach that guides the Maine Health Medical Group organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.
* The Revenue Integrity Analyst II plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.
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* Required Minimum Knowledge, Skills, and Abilities (KSAs)
* Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and three (3) to five (5) years' of experience within the revenue cycle. Experience above minimum requirement will be considered in lieu of education.
* License/Certifications: Applicable professional certification through AHIMA (RHIA, RHIT, CCS, CCS-P) or AAPC (COC, CPC), Nurse (RN), or Pharmacy Technician (CPhT, PTCB strongly preferred.
* Experience: Three (3) to five (5) years' experience in the hospital or practice setting, healthcare industry, billing, or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. Epic HB/PB experience preferred.
* Proficiencies: Advanced knowledge of revenue cycle processes and hospital/medical billing to include UB, RAs and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
* Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical -thinking and the ability to meet deadlines while influencing, but not directly managing the work of others. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
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