Revenue Integrity Analyst

Job Description

Join TriHealth as a Revenue Integrity Analyst! TriHealth offers a collaborative, mission-driven environment where skilled Revenue Cycle professionals can directly influence financial accuracy, compliance, and organizational performance. In this role, you will oversee and maintain the TriHealth Physician Charge Description Master (CDM), ensuring optimal revenue generation while upholding strict regulatory and payer requirements. You'll work closely with clinical departments, Information Systems, Compliance, Corporate Counsel, and other key partners to ensure accurate charge capture, timely documentation, and alignment with evolving CMS, CPT, and HCPCS guidelines.

Location:

• Works from Home

Work Schedule:

• Full-Time (80 hours bi-weekly)
• Day Shift
• No Weekend, Holiday or On Call Commitment

Benefits:

• TriHealth offers a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page

Job Requirements:

• Bachelor's Degree in Healthcare
• EPIC Physician Revenue Cycle & Coding
• Equivalent experience accepted in lieu of degree
• Certified Professional Coder (CPC)
• EPIC Experience in Physician based revenue cycle
• 4-5 years' experience Professional Healthcare EPIC Physician Revenue Cycle Coding & Charge Capture

Job Overview:

Assumes accountability in coordinating, monitoring, maintaining, updating & analyzing compliance of the TriHealth Physician Charge Description Master (CDM) to optimize revenue generation while ensuring compliance with third party payer requirements. Ensures timely review of regulatory literature such as CMS program transmittals, CPT & HCPCS guidelines/updates. Works collaboratively with revenue producing clinical departments and Information Systems to ensure all charges are captured & documented. Fosters a partnering relationship with Compliance/Corporate Counsel, Analytics, Patient Accounting, Medical Records and Managed Care. Monitors daily & monthly revenue and identify issues. Oversees daily revenue reconciliation. Evaluates and corrects, records missed charges as generated by advanced analytical queries. Evaluates and implements Revenue Guardian in collaboration with existing edits. Assists in resolving open encounters. Develops Corporate Policies that govern charge capture for physicians generate revenue. Evaluates and maintains optimal charge prices. Maintains TriHealth Physician Charge Description Master to optimize revenue generation while ensuring compliance with third party payer requirements.

Job Responsibilities:

• Maintains TriHealth Physician Charge Description Master to optimize revenue generation while ensuring compliance with third party payer requirements and evaluates and maintains optimal charge prices.
• Monitors daily & monthly revenue and identify issues. Oversees daily revenue reconciliation.
• Evaluates and corrects, records missed charges as generated by advanced analytical queries.
• Evaluates and implements Revenue Guardian in collaboration with existing edits.
• Assists in resolving open encounters.
• Develops Corporate Policies that govern charge capture for physician generated revenue.

Other Job-Related Information:

Working Conditions

• Climbing - Rarely
• Concentrating - Consistently
• Continuous Learning - Consistently
• Hearing: Conversation - Consistently
• Interpersonal Communication - Consistently
• Kneeling - Rarely
• Lifting <10 Lbs - Rarely
• Lifting 50+ Lbs - Rarely
• Lifting 11-50 Lbs - Rarely
• Pulling - Rarely
• Pushing - Rarely
• Reaching - Rarely
• Reading - Consistently
• Sitting - Frequently
• Standing - Occasionally
• Stooping - Rarely
• Thinking/Reasoning - Consistently
• Use of Hands - Frequently
• Color Vision - Consistently
• Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS

• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS

• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service

Respect: ALWAYS

• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone's opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS

• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS

• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community