Revenue Integrity Analyst

Atlanta, GA | Billing

Position Summary:

The Revenue Integrity Analyst ensures accurate and timely payments from third party payers in compliance with Managed Care contracts and government fee schedules. He or she will review trends in third party payments, compare actual payments to managed care contract reimbursement schedules and government payer fee schedules.

He or she will analyze third party denials and prepare relevant reports regarding trends in denials as well as determine root causes of denials and work with the appropriate departments to establish processes to ensure prevention of the denials. The Revenue Integrity Analyst will review coding audits for revenue capture opportunities and determine business impact.

The Revenue Integrity Analyst will develop, produce, validate and distribute standard management and ad-hoc reports as requested by end-users including but not limited to: GoHealth Revenue Cycle Administration, Department Administrators, GoHealth Managed Care Contracting.

The position will obtain, manipulate and analyze data from a variety of sources including but not limited to: physician billing systems, external contract management systems, and external claims systems.

JOB REQUIREMENTS

Education

  • High School Diploma or GED required
  • Bachelor’s Degree preferred

Work Experience

  • Minimum three years’ experience in a health care business setting
  • Five years of progressive responsible work experience in a medical group practice or hospital business office for large, complex health care environment

Required Licenses/Certifications

  • Epic Revenue Integrity, Physician Billing Certification, preferred

Additional Knowledge, Skills and Abilities Required

  • Ability to learn computer and application skills as applicable to role Excel, Epic, eCW
  • Knowledge of managed care contract reimbursement terms
  • Experience with computer systems, spreadsheets and database applications, data flow, report creation, and interpretation
  • Ability to interact with and work with peers and management
  • Ability to make judgments in demanding situations
  • Ability to react to frequent changes in duties and volume of work
  • Effective communication skills
  • Ability to logically organize details

ESSENTIAL FUNCTIONS

  • Work closely with Managed Care Contracting to ensure accurate set up of contract terms
  • Review reimbursement and variance reports from Epic and eCW
  • Assist in preparation of reports to share with payers when discrepancies in reimbursement are uncovered
  • Review and analyze reports to ensure timely receipt of payments from managed care contracted partners per terms of contracts
  • Establish audit trails for investigation of adjustments, refunds, write-offs and collection efforts by internal and external audit firms
  • Preparation of payer scorecards to share with Managed Care Contract partners for use during contract re-negotiations and quarterly business reviews
  • Develop and maintain denial reports to use for root cause analysis
  • Prepare reports or presentations to share the results of denial analysis with affected areas
  • Research, identify and analyze the impact of potential process changes after completion of root cause analysis of denials
  • Conducts claims analysis to verify charge master compliance and identify revenue improvements
  • Prepares and conducts educational services to departments and staff pursuant to audit findings, regulatory changes and requirements, and managed care billing requirements

All other duties as assigned.

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.


GoHealth provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. We invite military veterans to apply for our positions. In addition to federal law requirements, GoHealth complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.


Keywords:
Job, emergency, healthcare, licensure, medical, clinical, wellness, career, employment, opening, staff, benefits, health care, clinic, primary care, urgent care


Why GoHealth?

GoHealth Urgent Care has outstanding career opportunities in Connecticut, Missouri, New York City, North Carolina, Northwest Arkansas, Oklahoma City, San Francisco and the Portland-Vancouver area. And all of these positions have one thing in common: flexibility to practice urgent care medicine the way it was meant to be, without the stress and bureaucracy of hierarchical organizations. With reasonable work hours that don’t emotionally exhaust them or burn them out, our team can balance and prioritize their professional and personal lives.

The lifestyle you can lead.

Atlanta is Georgia’s state capital and home to approximately half a million residents. Well known for its arts, theater, galleries and museums, cultural attractions, and institutions of higher education, Atlanta offers many things to do. Visit Georgia Aquarium, the largest public aquarium in the Western Hemisphere. Shop and enjoy great entertainment in Underground Atlanta. See wildlife shows at Zoo Atlanta. Catch a pro football, basketball or baseball game. Foodies will delight in local favorites, such as crab fritters, chicken biscuits, pulled pork sandwiches and salted caramel ice cream. Choose from many welcoming neighborhoods to live in, from downtown and midtown to Chastain Park, and from Buckhead to Cabbagetown, Kirkwood and Morningside. There’s also a good selection of public and private schools and nearby colleges and universities. Public transportation is excellent, and Atlanta is also served by Amtrak and Hartsfield-Jackson Atlanta International Airport.