Revenue Integrity Analyst at Nemours in Orlando, Florida

Job Description:

Nemours is seeking a Revenue Integrity Analyst to join our Nemours Children's Hospital team in Orlando, Florida.

Located in Orlando, Fla., Nemours Children's Hospital is the newest addition to the Nemours integrated healthcare system. Our 100-bed pediatric hospital also features the area's only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Children's Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout.

• Maximizes charge efficiency through (a) monitoring revenue cycle processes and staff functions; (b) supporting Nemours Children's Hospital and Nemours Specialty Care Services-Orlando revenue capture integrity by evaluating the accuracy of charge capture and billing functions and staying apprised of payor and/or regulatory updates; (c) assisting in the design and implementation of charge capture/billing workflow improvements.
• Maximizes reimbursements through (a) monitoring and reporting on claim denials and zero payments; (b) communicating with key stakeholders actions steps to prevent denials and zero payments; (c) work collaboratively with central business office to assure appropriate appeals of denials and/or coding adjustments to prevent denials.

• Leads the development and refinement of charge capture workflows.
• Leads the development, fine tuning, and auditing of charge capture reconciliation.
• Develops and maintains dashboards and reports on charge capture and charge capture reconciliation.
• Monitors, reports, and takes action on trends in claim denials and zero payments.
• Recommends front end staff education and communication for denial prevention.
• Develops and maintains dashboard and reports on denial and zero payment management and prevention.
• Prepares summaries that pinpoint root causes of charge and billing errors.
• Participates in Charge Master (CDM) and Physician fee schedule maintenance efforts
• Additional miscellaneous duties and responsibilities, as may be assigned.

• Bachelor's Degree required.
• Minimum of three (3) to five (5) years experience required.
• High level analytics skills required.
• Revenue cycle/revenue integrity experience required.
• Understanding of medical coding required. Certified Professional Coder (CPC) preferred.
• Strong Excel skills. Experience in using business intelligence tools.