A Revenue Integrity Analyst ensures accurate and timely payments from third-party payers. Some of the common work activities are mentioned on the Revenue Integrity Analyst Resume as – reviewing trends in third party payments, preparing relevant reports for management review, analyzing third party denials, determining root causes of denials, and working with the appropriate departments to produce, validate and distribute standard management and ad-hoc reports, ensuring accurate set up of contract terms, reviewing reimbursement and variance reports, identifying and trending discrepancies in allowed amounts, and preparing reports or presentations to share the results of denial analysis.
Summary of skills that highlight a resume are – extensive knowledge of managed care contract reimbursement terms for enterprise, the ability to interact with and work around people, the ability to logically organize details, and experience working in a medical group practice. A bachelor’s degree in finance, economics, business analysis, or a related field is required for this role.
Objective : Dedicated and focused Revenue Integrity Analyst with proven strengths in patient care,coding and chart auditing, patient audits, analyzing and resolving billing edits that require clinical, financial expertise and Technical support in healthcare systems. Exceptional capacity to multi-task: manage numerous, often competing priorities with ease and the provision of superior patient care.
Analyzed and resolved specific billing edits that require clinical expertise that are delaying claims from processing in the Patient Accounting and/or SSI systems.
Modified and condition codes, as appropriate.
Identified charged, coded, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues.
Performed charge audits by verifying billing data as compared to documentation and making corrections in Patient Accounting as needed.
Analyzed audit findings, recommendations are made to facility ancillary department directors in order to improve documentation, charging flow, and accuracy.
Assessed impact to Revenue Integrity procedures and implement changes as needed.
Participated as a member of the facility FECC Committee and report charging issues as appropriate.
Experience
2-5 Years
Level
Junior
Education
Diploma
Revenue Integrity Analyst Resume
Objective : An experienced Revenue Integrity Analyst with proven success and expertise in Emergency Department Physician coding and auditing, seeking employment in a same or similar field. Qualified for a position in coding and auditing for the following reasons: I am double certified with AHIMA and AAPC.
Skills : Medical Billing Software, ICD-9 And CPT/HCPCS, Knowledge Of Medicare/Medicaid Billing.
Description :
Thoroughly analyzed and effectively resolved patient claims being held for billing edits prior to final billing, consistently maintaining current working knowledge of CPT and ICD-9 principles, government regulations and third party requirements to ensure optimal billing practices.
Productively conferred with providers/medical professionals on billing and supporting documentation policies, procedures and regulations.
Concurrently assisted with office/clerical functions supporting efficient operations.
Trained and assisted new employess with orientation in performing daily tasks.
Assisted employees with new database training.
Served as a liaison between the SSC Charge Master department and the facility ancillary department directors Review HCA Regs Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD).
Coordinated the overall reservation processes between Front Office Managers, Revenue Manager and resort staff.
Experience
2-5 Years
Level
Junior
Education
Bachelor Of Science
Revenue Integrity Analyst Resume
Headline : An able, enthusiastic, skilled, and reliable individual seeking a position that reflects my experience, skills, and personal attributes. A self-motivated, and work well individually or as a team member. I have experience working in a fast-paced, dynamic work environment, including dedication, meeting goals, creativity and the ability to follow through.
Skills : Microsoft Office, Epic, Meditech, Greenway.
Description :
Resolved Billing Edits that hold patient claims from billing, by reviewing medical records and other applicable documentation.
Maintained the integrity of facility Charge Master.
Provided monthly compliant and external billing audit results.
Developed and coordinated billing issues while handling inquires generated by the system, and assist in internal audits.
Interpreted a variety of state and federal regulations and determine effect on CDM and claims production.
Analyzed and resolved patient claims being held by billing edits on Bill 45, Bill 49, and CRT, medical necessity.
Identified charged, coded, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership.
Experience
5-7 Years
Level
Executive
Education
GED
Revenue Integrity Analyst Resume
Summary : Responsible for Working closely with front office manager ensuring reservation procedures are consistent with check-in procedures, and also Coordinating all written correspondence responses from owners and guests regarding rental activities, policies disputes, and complaints.
Skills : Microsoft Office, Business Intelligence, Artiva.
Description :
Analyzed and resolved specific billing edits that require clinical expertise that are delaying claims from processing in the Patient Accounting and/or SSI systems.
Reviewed the medical record, facility protocol, and other applicable documentation.
Included the application of modifiers and condition codes as appropriate.
Identify charged, coded, or clinical documentation issues and work with appropriate leadership and ancillary departments to resolve issues.
Performed charge audits by verifying billing data as compared to documentation and making correction in Patient Accounting as needed.
Analyzed audit findings, recommendations are made to facility ancillary department directors in order to improve documentation, charging flow, and accuracy.
Served as liaison between Charge Master department and facility Ancillary department directors.
Experience
7-10 Years
Level
Management
Education
MS
Revenue Integrity Analyst Resume
Headline : Seeking a Revenue Integrity Analyst position where my professional experience, knowledge capabilities will allow me to make an immediate contribution as an integral part of this company.
Skills : Word processing, Data entry, Proficiency.
Description :
Reviewed of patient charges for appropriateness & Charge Description Master (CDM) assigned HCPCS/CPT coding by reviewing the medical record, facility protocol & other applicable documentation.
Served as liaison between facility, administration, Shared Services Center & ancillary department directors regarding charging issues, clinical documentation issues & revenue opportunities.
Provided audit results & developed and coordinated educational in-services for facility staff related to charging/billing issues.
Reviewed and correct billing edits on accounts that post on request or other systems.
Kept abreast of current changes in Medicare, Medicaid, and government funded payers billing requirements.
Completed mandatory training courses as they pertain to this position through the education systems.
Experience
5-7 Years
Level
Executive
Education
MS
Revenue Integrity Analyst Resume
Summary : Dedicated, diligent, reliable, and personable professional with superior critical thinking skills and a strong work ethic Proven track record of an exceptional ability to deliver competent and dignified patient care while serving as an active patient advocate. Repeatedly commended by patients and their families, supervisors, and colleagues. I possess outstanding interpersonal and communication skills. I readily develop rapport with patients and their families, as well as members of the healthcare team.
Skills : Medical Billing, Medical Insurance, Medical Claims Processor, Patient Account Representative, Medical Office, Customer Service, Medicare, Data Entry.
Description :
Supervised sales and administration staff through the thorough reporting and auditing procedures in place.
Utilized extensive IT knowledge and analytical skills to assist in the amending of daily reporting procedures, further streamlining business processes.
Met demanding deadlines for the preparation of monthly financial and performance-related management reports.
Distributed and presented these findings to management.
Assisted in the rollout of new reservation software to existing sales staff and promoted the benefits of new procedures.
Edited for many different reasons.
Reviewed trends for documentation & charging opportunities.
Experience
7-10 Years
Level
Management
Education
GED
Revenue Integrity Analyst Resume
Headline : To pursue a Revenue Integrity Analyst position within an organization that provides growth and development opportunities that offers an array of benefit options.
Skills : Microsoft Office, Supervising Skills.
Description :
Responsible for auditing claims submitted to ensure that proper commercial and Medicare guidelines have been adhered.
Monitored itemized billings for excessive charges, duplications, unbundling, and medical coding errors.
Reviewed medical record documentation as needed to obtain basic information to validate billing information and charges.
Maintained a follow-up system for updating, and releasing pending claims when indicated.
Analyzed and reviewed QA Processing Performance Indicator reports and resolves OCE edits to ensure accurate facility reimbursement and to prevent overpayments from re-occurring.
Created revenue models based on new contract terms in accordance with established contract and fee schedule criteria.
Modeled revenue utilizing various payer plan contracts for a 13 hospital healthcare system.
Experience
5-7 Years
Level
Executive
Education
MS
Revenue Integrity Analyst Resume
Objective : Hardworking, organized, Revenue Integrity Analyst professional with a proven background delivering sensible business technology solutions on time and under budget while working as a team member or team leader.
Skills : Planning Skills, Multitasking.
Description :
Managed a 10% operating margin by utilizing strong Pro Forma models with revenue exceeding $80 million for contract negotiations.
Designed Quality Improvement initiatives for revenue cycle operations.
Maintained and Model Nuvance Health Values and Code of Conduct.
Managed and analyzed back end reports to identify and capture missed charges.
Served as a subject matter expert related to charging and billing issues, and assists in developing and maintaining related policies and procedures.
Performed daily audit maintenance functions to ensure compliance, accuracy, and consistency of charges.
Provided guidance, communication and education on correct charge capture, coding and billing processes to multiple clinical departments and facilities.
Experience
2-5 Years
Level
Executive
Education
MS
Revenue Integrity Analyst Resume
Headline : Responsible for Booking reservations for all property guests and inform them of services provided at the property, Assisting reservation counselors with challenging calls.
Skills : Excel, Medical Terminology, Medical Records, Medical Billing, Revenue Cycle, HCC Coding.
Description :
Led and participated in moderately complex projects related to revenue cycle initiatives.
Stayed current with regulatory revisions in payment methodologies via seminars, websites, etc.
Worked closely with department managers in adding/changing/deleting any charge codes within our fee schedules and insurance master.
Researched and distributed relevant charge services related regulatory updates to applicable department heads.
Worked closely with Patient Accounting to ensure all billing edits and coding edits are corrected within Revenue Cycle, where applicable.
Actively participated in all Revenue Cycle related special projects as well as daily, monthly and yearly reporting.
Worked with Managed Care to ensure appropriate contract information is in place regarding precertification and authorization requirement in specialty areas.
Experience
5-7 Years
Level
Executive
Education
Diploma
Revenue Integrity Analyst Resume
Summary : A Revenue Integrity Analyst professional with over 10 years of experience. I have experience in the healthcare, insurance, and finance industries. Proven computer skills through proficient daily use of many programs such as Microsoft office, Oracle Business Objects, and Artiva, just to name a few. Recipient of the Certificate of Excellence for outstanding performance and lasting contributions in ethics, compliance, and corporate responsibility from HCA North Florida Division.
Skills : Communication Skills, Time Management.
Description :
Worked with Coding Departments, Registration areas and Information Technology Services to ensure proper setup of new service line charging, coding, and billing, as well as appropriate flow of charts for coding.
Demonstrated regular, reliable and predictable attendance.
Monitored and ensured rate integrity between distribution channels.
Controlled and balanced inventory in wholesale and online maintenance systems in a timely manner.
Recognized potential for increased rental revenue and recommend/take appropriate action to implement.
Maintained and monitored group inventory and activity.
Reviewed group cut-off dates to ensure group blocks are released and returned to inventory.
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