The Revenue Integrity Analyst RN reviews and revises accounts to achieve revenue enhancement and compliance. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing.

RESPONSIBILITIES:

• Performs specialized audits of revenue cycle processes.
• Utilizes specialized software programs such as Connect Care, Medassetts Xclaim, Excel and other systems to identify and review patient accounts based on criteria provided.
• Compares medical documentation, detailed account information and claim for selected patient accounts.
• Documents and analyzes revenue cycle processes including charge capture, medical documentation, and billing.
• Performs routine compliance audits.
• Maintains and provides information on status of audits and issues presented.
• Participates in quantifying audit outcomes, including revenue realized.
• Researches and communicates appropriate treatment of charges to clinical managers, CDM Specialist (coordinator), other customers.
• Researches technical guidance in UB-92 Editor, CPT/HCPCs Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance.
• Participates in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
• Resolves billing issues with CBO.
• Participates in periodic departmental review of new regulatory developments and their impact and researches regulatory changes.
• Performs Customer service audits and provides necessary feedback to resolve patient concerns including explaining itemized entries on patient accounts.
• Acts as liaison and resources to Patient Financial Services staff in answering questions regarding charges, supplies, and nature of service.
• Serves as primary contact for third party defense audits.
• Performs defense audits within the guidelines established by contractual agreements or the Audit Policy.
• Effectively uses automated systems to perform work assignments.
• Performs related duties as assigned.

QUALIFICATIONS/REQUIREMENTS:

Minimum five years clinical experience in a hospital setting, preferably cardiology, radiology, surgery or utilization review. Previous revenue integrity experience, Excel and Electronic Medical Records experience preferred. Familiarity with medical record documentation standards and practices health care insurance billing issues, and federal and state billing compliance issues for hospitals, knowledge of CPT-4 codes and ICD-9-CM codes is required. Current NYS Professional Nursing License and Registration required. Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H) preferred.

EDUCATION:

Graduation from an approved School of Nursing, BSN preferred.

OTHER:

If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

About Us:

Good Samaritan Hospital

Good Samaritan Hospital in Suffern, NY, is a 286-bed hospital providing emergency, medical, surgical, obstetrical/gynecological and acute-care services to residents of Rockland and southern Orange counties in New York; and northern Bergen County, NJ. The hospital is home to a recognized cardiovascular program, comprehensive cancer-treatment services, the area's leading Wound and Hyperbaric Institute and outstanding maternal/child services that includes a Children's Diagnostic Center. Good Samaritan Hospital also provides social, psychiatric and substance-abuse services and its certified home-care agency supports residents of the Hudson Valley and beyond.