Under the direction of the Director of Revenue Integrity and Coding at Harvard Medical Faculty Physicians (HMFP), the Revenue Integrity Senior Analyst supports enterprise-wide revenue integrity and coding oversight. This role focuses on improving processes, identifying risks, monitoring operational and financial metrics, and ensuring adherence to standards and policies.
Primary responsibilities include:
- Monitor departmental adherence to professional charge reconciliation, work-queue, and coding quality expectations.
- Conduct periodic reviews of charge reconciliation processes to ensure accurate capture and reporting of professional charges.
- Review and document changes to the charge description master (CDM) and fee schedules and route them for approval.
- Lead annual, quarterly, and ongoing CDM and fee schedule maintenance activities.
- Review CPT, HCPCS, and wRVU changes for accuracy, compliance, and reimbursement optimization.
- Support departments with coverage and reimbursement analysis.
- Identify revenue management opportunities and stay current with government and commercial payer requirements.
- Develop and deliver revenue integrity and coding education and training programs.
- Monitor, investigate, and report revenue integrity and coding quality concerns.
- Track regulatory and legislative changes affecting the program.
- Monitor coder audit results and productivity and support process improvement efforts.
- Lead assigned projects, committees, and meetings.
- Develop tools and processes to identify delayed or lost revenue.
- Prepare reports and presentations for leadership and stakeholders.
Requirements & Qualifications
Required qualifications
- Bachelor’s degree required.
- Certified Professional Coder (CPC) required.
- 5 or more years of physician/professional revenue operations experience in coding, revenue integrity, charge reconciliation, charge compliance, charge auditing, or CDM management.
- EPIC PB experience preferred.
- Strong knowledge of revenue cycle processes, physician billing, CPT, HCPCS, ICD-10, reimbursement methodologies, NCCI edits, Medicare LCD/NCDs, and healthcare compliance requirements.
- Knowledge of medical terminology, anatomy and physiology, and clinical department activities.
- Ability to manage complex projects, investigate issues, and resolve problems at a high level.
- Excellent communication, presentation, organizational, analytical, and problem-solving skills.
- Strong independent judgment, attention to detail, and ability to work in a fast-paced, collaborative environment.
- Advanced Microsoft Office skills, including Outlook, Word, Excel, PowerPoint, Power BI, and web-based applications.
Location
Massachusetts, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$55,370 - $74,110
Remote work allowed
No
Posted
3 weeks ago