Billing Integrity Analyst

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Job Type:

Regular

Scheduled Hours:

40

Why You’ll Love Working with St. Elizabeth Healthcare

At St. Elizabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We’re guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork. Our associates are the heart of everything we do.

 

Benefits That Support You

We invest in you — personally and professionally.

Enjoy:

- Competitive pay and comprehensive health coverage within the first 30 days.

- Generous paid time off and flexible work schedules

- Retirement savings with employer match

- Tuition reimbursement and professional development opportunities

- Wellness, mental health, and recognition programs

- Career advancement through mentorship and internal mobility

Job Summary:

This position performs daily quality control (review, correction, and feedback), ensuring the timeliness, accuracy and compliance of revenue capture for St. Elizabeth Healthcare charges. As well as charge capture audits on a concurrent and retrospective basis, to reconstruct the itemized billing statement/UB04 from the source documentation. Charges not captured and charges that may have erroneously been captured are identified. This position includes charge development, lost charge analysis, account audits/analysis, Charge Description Master support and maintenance, timely filing, and unbilled accounts receivable root cause analysis resulting in reimbursement optimization. This position will also perform defensive audits as necessary.

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Job Description:

• Assigns appropriate billing/coding (modifiers) as related to defense audits, charge capture, ABNs, billing edits and completes all work queues.  Follows accounts to resolution. The percentage of time spent on this, and all job duties below, can vary depending on the employee’s home department.
• Identifies trends and areas of opportunity strategies to reduce edits and improve compliance.  Provides comprehensive reporting and analysis.
• Understands Medicare, Medicaid and managed care contract payment guidelines (including carve outs) to notice correct reimbursement. Reviews and follows-up on edits, denials, appeals, and lost claims.
• Effectively communicates edit/audit/denial findings to the various departments throughout the organization.  Participates in policy / procedure / work plan designs as new audits /edits are uncovered.
• Adheres to the National Care Billing Audit Guidelines and St. Elizabeth’s corporate compliance program while performing all duties detailed.
• Assists with new charge development and CDM support and maintenance.
• Performs other duties as assigned.

Education, Credentials, Licenses:

• High School Diploma

Specialized Knowledge: 

• Knowledge of how services provided by the hospital are billed
• Experience with EPIC, MIDAS
• Ability to identify from the chart the pertinent documentation to substantiate billed and unbilled charges.
• Previous utilization review and knowledge of applicable state, federal, and third-party regulations and standards
• Excellent interpersonal skills for interfacing with department heads, third party auditors, hospital personnel and patients.
• PC skills using multiple systems/applications including EPIC
• Ability to perform autonomously, utilizing critical thinking skills

Kind and Length of Experience: 

• 3 years medical audit, coding or healthcare related field experience

FLSA Status:

Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.