Rev Integrity Analyst

At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

Position Summary: 

The role the Revenue Integrity Analyst is to assist Central Maine Healthcare (CMH) organizations in identifying and implementing process improvements in an effort to operate a “best in class” revenue cycle.  This position serves in a key role to improve the overall effectiveness of revenue cycle policy, practices and technology platforms for all CMH organizations.

The Revenue Integrity Analyst is an analytical and process improvement role with a primary focus of working on revenue cycle tasks directed by department leaders with the purpose of improving revenue cycle process outcomes – specifically related to one or more of the following areas:

• Charge Master Maintenance and Accuracy
• Charge Capture Completeness, Accuracy and Reconciliation
• Payment Variance Analytics, Reporting and Prevention
• Regulatory Adherence across Revenue Cycle departments and organizationally
  • Provider Based Status and Facility Enrollment
• Revenue Cycle Reporting & Analytics
  • Financial Improvement Goal Setting, Process Improvement, Tracking and Reporting
  • Data Trending
  • KPI and Operational Dashboards and Reports
  • Supporting Organizational Dashboards and Reports
• Vendor Management
• Revenue Informatics development
  • Systems Support
  • Quality
  • Training
  • Policies
  • Professional Development
  • Workflow Redesign and Enhancement

This position requires competency in revenue cycle, financial, business, clinical or other analytical skills with a focus on key performance metrics. The primary responsibility of this role is to assist in data and information needs to show both gap in performance as well as measurement of initiatives and tactics. The Analyst will serve as a resource for teams working on major, complex performance improvement efforts that affect multiple facility and clinical practice revenue cycle protocols throughout CMH.   

It is critical that this position be highly effective in delivering the services described in the Job Functions and Duties and work harmoniously with leaders and staff across CMH.  Effectiveness will be measured in terms of results, commitment to CMH and customer satisfaction (at all levels).

Essential Duties:

• Support Revenue Cycle leaders to ensure effective process review, improvement or redesign for efficient revenue cycle operations. 
• Ensure development of industry best practice operating procedures with consistent application in all business units by providing industry knowledge and subject matter expertise. 
• Focus of working on tasks directed by department leaders with the purpose of improving revenue cycle process outcomes.  
• Requires competency in revenue cycle, financial, business, clinical or other analytical skills with a focus on key performance metrics. 
• Gather requirements, analyzing findings, recommending solutions, implementing new and improved processes and recommending ongoing controls and protocols as well as monitoring the existing processes.
• Success measured in terms of assisting teams to achieve financial and other tactic, high quality output, and customer service satisfaction.
• Perform root cause analysis to understand the business issues and summarize data challenges for all CMH organizations.
• Review, reconcile, and analyze management data including vender service placements, to identify fragmented processes and make recommendations for improvement.
• Provide support for inquiries or issues related to improvement.  May assist with research, diagnosis and help resolve problems and escalates to leadership as needed.
• Apply appropriate reconciliation and testing to analytical results to provide high quality and accurate results.
• Assist in data interpretation, communication, and presentations around key performance indicators.
• Assist in gap analysis and transforming data into useful information.
• Update scorecards and other data tools to help provide actionable information.
• Review and analyze functions to identify fragmented process and make recommendations for improvement.
• Identify opportunities for process improvement utilizing key indicators and will facilitate corrective action in collaboration with others.
• Assist with special analysis and projects as needed.
• Coordinate a collaborative process for the development of policies, procedures, and internal controls.
• Work collaboratively with manager/director to identify best practices and help develop performance standards that can be tracked and reported.
• Work collaboratively with management personnel to identify processes that negatively impact Revenue Cycle outcomes.

Technology

• Assist in review and optimization of current technology, support assessing and recommending new information technology solutions and or manual changes that support departmental functions.
• Work collaboratively with departmental personnel to implement systems and process changes aimed at improving Revenue Cycle performance.
• Ensure compliance with outside regulatory requirements are documented (i.e. Pricing Transparency, CMS regulations, Managed Care contract terms)

Management Reporting and Monitoring

• Populate on-going Revenue Cycle KPI’s based on computer generated data and manual reports.
• Utilize departmental work plans to monitor initiative and project goals, progress, and outcomes.
• Facilitate compilation of performance metrics reporting, analyze results and recommend corrective action.

Professional Development

• Attend local and WebEx seminars to remain current in supporting the needs of revenue cycle activities.
• Remain current in data analytics knowledge by attending various seminars and classes relevant to current business needs.
• Reviews Third Party Regulatory publications to maintain knowledge base concerning compliance, billing requirements, reimbursement, industry benchmarks and coverage issues. 
• Maintains current knowledge of regulatory developments involving agencies such as CMS and MHA.

Communication 

• Maintains awareness of verbal/ nonverbal communication in interactions with staff, other departments, physicians (providers), patients, and families as required 
• Maintains patient, staff and hospital confidentiality in all communication interactions: written, verbal, electronic and digital  

Customer Service 

• Displays positive attitude. Treats others with honesty and respect. Speaks positively in all customer interactions internal and external.

Education and Experience:

• Bachelor’s degree required, or five (5) years related revenue cycle experience in lieu of, and
• Four (4) years of experience in Finance or Revenue Cycle

Knowledge, Skills and Abilities:

• Detailed knowledge of Revenue Cycle, reimbursement, and regulatory information
• Knowledge of business analysis techniques is preferred.
• Working knowledge of all functional areas of the revenue cycle, including contract and denial management, CDM and charge capture management, coding, vendor management, registration, billing, customer service, etc. with specialized subject matter expertise in at least one area.
• Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10), and HIPAA ANSI codes (remark and adjustment codes).
• Intermediate Microsoft software knowledge and ability to train/assist end-users.  
• Ability to interpret an extensive variety of instructions furnished in written, oral, diagram, or schematic form.   
• Creative and “outside of the box” problem solver is necessary for this position.
• Flexible and able to react to ever changing priorities.
• Advanced experience with business applications such as Excel, Power Point, Visio
• Working knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
• Working knowledge with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
• Working knowledge of Medical Record, Financial Services and Healthcare Application technology. 
• Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations. 
• Able to effect collaborative alliances and promote teamwork.
• Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
• Effective organizational, planning, controlling, scheduling and project management abilities.
• Experience or proven aptitude in the management of multiple projects and priorities.
• Financial acumen with ability to extract data, ensure integrity, produce reports and utilize for communicating results and affecting change.
• Ability to positively influence change. 
• Excellent communications skills, both oral and written. 
• Demonstrated ability to work well with diverse people, excellent human relation skills.
• Flexible and able to react to ever changing priorities.
• Ability to engage patients and team members utilizing the CMH Experience Standards

  I am creating a warming, caring, and non-judgmental environment

  I am actively listening and seeking information

  I am honest, truthful, and consistent

  I am respectful, treating all individuals with dignity and empathy

  I am serving as a role model, taking both initiative and ownership when appropriate

  I am working collaboratively and demonstrating teamwork

  I am resilient and adapt to change in positive ways.

• Demonstrated ability to direct and triage in a highly fluid dynamic operational environment.
• Ability to collaborate with all layers of the management/ administration team. 

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!