JOB SUMMARY

The Revenue Integrity Analyst 1 manages small projects and less complex service lines with some oversight, to ensure system-wide charge capture activities are performed in adherence to Baylor Scott & White Health (BSWH) processes, policies, and applicable State and Federal guidelines. This position develops and maintains an exceptional working knowledge of their assigned primary service line(s), key relationships, and represents their service line(s), Revenue Integrity, and the broader Revenue Cycle to individual contributors as well as department, facility, and system leadership.

QUALIFICATIONS

• EDUCATION - Bachelor’s or 4 years of work experience above the minimum qualification
• EXPERIENCE - Less than 1 Year of Experience

• Assists in developing and maintaining a standardized charging methodology across all facilities for assigned service line(s) and partners with IS to design, build, validate, and test workflows impacting the Revenue Cycle. Develops detailed knowledge of charge capture workflow and mechanisms in order to support the IS teams with build required to achieve anticipated charging outcomes.
• Manages small charge capture projects and initiatives for assigned service line(s) with some oversight. Identifies problems by evaluating business requirements, examining data, negotiating organizational consensus, and synthesizing key messages for communication to all stake holders. Collaborates with numerous teams to support charging and billing accuracy efforts.
• Performs charge capture audits and education with some oversight. Designs, creates, and conducts audits and data-backed assessments to evaluate compliance with BSWH policies, procedures, and applicable laws related to charging practices for assigned service line(s). Formulates recommendations and corrective actions based on audit findings. Compiles written audit report detailing risks and financial impacts of deficiencies and proposing solutions for mitigation with some oversight.
• Examines accounts, claims, and clinical documentation for charge capture and billing quality and accuracy. Interprets documentation from medical records to validate charges. Provides feedback and education, as appropriate, depending on findings.
• Ensures the accuracy of the Charge Description Master (CDM). Evaluates critical data elements in the CDM to ensure adherence to CMS, AMA, third party payor, and other applicable state and federal guidelines across related departments. Validates all changes for data integrity.
• Reviews, interprets, and implements any coding and billing changes impacting the assigned service line(s) related to the quarterly and annual CPT update processes. Evaluates clinical processes to establish what changes are required to accommodate updated coding and billing regulations.
• Provides charge reconciliation education to assigned service line(s) and associated clinical departments, with oversight as needed. Performs frequent audits to ensure department compliance.
• Helps the success of new department, facility, service, workflow, or methodology go-lives by performing charge capture audits to ensure go-live success and rounding with department leadership and key stakeholders to ensure operational success while providing an avenue for questions and escalations.
• Performs other position appropriate duties as required in a competent, professional, and courteous manner.