Revenue Integrity Analyst

Overview

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center  (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

 

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

 

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

 

To learn more, visit www.cmhc.org.

Responsibilities

The Revenue Integrity Analyst determines the appropriateness of patient charges based on the Charge Description Master (CDM) and assigned HCPCS/CPT coding, by reviewing and analyzing the medical record documentation against the itemized bill, clinical procedures, department documented charging practices, facility protocol, and other applicable practices. This review includes the verification of charging and billing data for accuracy and completeness and compliance with regulatory requirements to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, ePremis, or in the payers system. This position also serves as a liaison between facility administration, patient accounts and ancillary department directors, regarding charging issues, clinical documentation issues and revenue opportunities. Providing review results and developing and coordination educational in-services for facility staff related to charging/billing issues is also a key responsibility of this position. At times, this position may collaborate with the compliance Analyst to perform retrospective, concurrent, patient requested, and external billing audits.

Qualifications

EDUCATION, EXPERIENCE, TRAINING  1. Five years experience in a role related to revenue capture/charging, auditing, coding or compliance is required. 2. Clinical experience is preferred. 3. Experience with PCs, word processing, spreadsheet, graphics, and database software applications is required. 4. Strong quantitative, analytical and organization skills. 5. Proficient in chart review, clinical record information systems and coding methodologies. 6. Ability to understand and interpret medical records, hospital bills, and the ChargeMaster. 7. Ability to understand all ancillary department functions. 8. Excellent written and verbal communication skills. 9. Excellent critical thinking skills. 10. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff and hospital management staff. 11. Ability to work independently in a time-oriented environment. 12. Computer literacy and familiarity with the operation of basic office equipment. 13. Assertive personality traits to facilitate ongoing administration communication. 14. Working knowledge of Medicare reimbursement system and coding structures preferred.

 

Pay Transparency

Central Maine Healthcare Corporation offers competitive compensation and a reasonable compensation estimate for this role is $28.89 to $40.54. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf