Revenue Integrity Analyst

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. The Opportunity: CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position starts at $47,400. Final compensation will be determined based on experience. The Revenue Integrity Analyst plays a pivotal role in ensuring financial health for acute and non-acute organization by meticulously managing the charge master, regulation code changes, work queues, charge capture, charge reconciliation, reporting, and analytical trending. This includes the identification of root cause and creation/maintenance of processes to ensure charge capture. In addition, this position is required to provide analytical insight regarding reports for charges that are not captured accurately or consistently. This position is responsible for uncovering root causes and developing a correct action plan. Recommends modifications to established practices and procedures or system functionality as needed to support Revenue Cycle and then manages implementation of those recommended changes. Job Competencies: Valuing Differences - Works effectively with individuals of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds; seeks out and uses unique abilities, insights, and ideas. Considers the collective. Collaboration - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success; focuses on the results of the team, not the achievements of one person. It’s “All for One and One for All” Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone who is willing to step up and own it. Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently. Developing Trust - Gains others’ confidence by acting with integrity and following through on commitments; treats others and their ideas with respect and supports them in the face of challenges. Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required; is proactive and pursues relentlessly. Essential Job Functions: Charge Master Evaluates current charging processes to diagnose the root cause of any charge inefficiencies and ensures standard charge practices are implemented. Analyzes changes to coding and billing rules and regulations and using independent decision making to ensure appropriate updates to CDM and charge processes are implemented. Prepare and present quarterly and annual CPT/HCPCS changes, annual pricing updates and provide client education material and presentation. Conduct thorough research to ensure the Charge Description Master (CDM) is maintained regularly. Leads efforts of collaboration with multi-disciplinary groups responsible for monitoring and assuring the accuracy and enhancement of hospital net revenue through management of the hospital charge master. Operational Improvement Collaborates with stakeholders in revenue enhancement projects including Denial Management, APC Billing and/or other committees as needed. Provides leadership and expertise with various groups to develop new areas of review for future revenue enhancement and/or compliance initiatives. Conduct thorough analysis of billing errors and denial data to diagnose root causes. Utilizes independent decision making to execute work plans to correct identified deficiencies related to charge problems. Responsible for problem solving and resolution of complex claim edits. Stay up-to-date with industry trends, emerging technologies, and regulatory changes affecting healthcare revenue cycle management and proactively share knowledge with the team. Perform Quality Assurance on team members, as needed. Trending and analysis of key data to identify areas for additional education. Charge Capture Serves as subject matter expert (SME) of charge capture methodologies and helps investigate and solve charging issues and provide charge capture recommendations to clinical departments and hospital staff. Collaborate with client leadership to ensure charge trigger matrix is clearly documented and updated, as needed. Diagnoses root cause issues of charge problems and provides client education for best practice recommendations for improvement. Conduct root cause analysis on late charge reporting and provide client education for timely charge capture. Ensure effective monitoring and internal control processes in place to improve revenue capture. Rounding with Clients Rounding on client revenue leaders on a quarterly basis to review questions concerning charge reconciliation, charge processes, CDM. Attend meetings to support system conversions, revenue cycle initiatives and foster good working relationships with key contacts. Additional Job functions: Identify operational performance and revenue opportunities through detailed data review. Ensure effective monitoring and reporting control processes in place to improve performance. Evaluation of current processes and tools and propose changes in order to drive efficiencies within Revenue Cycle. Coordinate operational objectives by contributing information and recommendations to strategic plans and reviews; preparing and completing action plans. This position will be proactive in auditing and reconciling his/her own data findings, report results in order to maintain improve the quality and integrity data provided by the analyst. Experience We Love: 3-5 years related experience required Excellent knowledge of Epic, Excel and SQL queries. Working knowledge of CPT & HCPCs coding guidelines. Excellent computer, proof reading, and written and verbal communication skills. Excellent interpersonal skills including the ability to communicate effectively with CHP internal and external customer base. Ability to work independently, proactively with limited supervision and also as a team player when called upon. Ability to work under pressure. Ability to maintain the security of confidential information. Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences. This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require. Minimum Education: Bachelor’s Degree or equivalent experience Certifications: CRCR Required within 9 months of hire (company paid) Join an award-winning company Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 Innovation Work-Life Flexibility Leadership Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs. Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation. Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected] . This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range. Employment Disclaimers – Ensemble