Revenue Integrity Analyst I - Decision Support

The Revenue Integrity Analyst maintains the integrity of the Revenue Integrity program within the Decision Support Department team to ensure compliance with Medicare/Medicaid regulations, Managed Care contractual agreements and the applicable policies of UT Southwestern University Hospital.

• Assist in daily resolution of billing edits that are holding patient claims from billing
• Reviewing medical records and other applicable documentation
• Identify, report and participate in the resolution of any potential or actual revenue/charge related issues
• Performs internally defined audits to identify under/over charges; reviews charges posted to the claims against the necessary clinical documentation to identify any possible under/over charges; documents audit findings and sends results to appropriate departments

This is a 100% work from home position. However, you must live within the state of Texas and available to come into the office for meetings, trainings, etc., if required.

Bachelor’s degree in Healthcare Administration, Business, or other related degree and three (3) years’ experience in the hospital setting, healthcare industry or coding. Applicants with significant additional related experience may be considered in lieu of education. EPIC HB/PB experience preferred. Applicable professional certification through AHIMA (CCA) or AAPC (CPC A, COC-A) are highly desirable and preferred.

• Assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Expected to identify, report, and participate in the resolution of any potential or actual revenue/charge related issues. Performs internally defined audits to identify under/over charges; reviews charges posted to the claims against the necessary clinical documentation to identify any possible under/over charges; documents audit findings and sends results to appropriate departments.
• Monitors EPIC Revenue Integrity Dashboard. Reviews patient records and is able to assist with account fixes, charge reconciliation for other departments based on clinical documentation.
• Responds to departmental charging inquiries timely. Follow up with appropriate health team members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop education strategies to promote complete and accurate clinical documentation and correct negative trends. Works with various staff and departments such as Health Information Management, clinical nursing units, physicians, and others to obtain the information necessary to perform account audits.
• Works with Coding and other clinical departments to identify/fix errors based on ICD/CPT Coding Guidelines and National Correct Coding Initiative edits. Review payments for accuracy from contracted payers. Performs account corrections via all types of EPIC work queues. Identifies trends, recommends corrective action steps, and collaborates with team members to educate healthcare staff.
• Serves as subject matter expert to leadership on issues related to Revenue Integrity
• Completes special projects as identified and needed
• Stays abreast of on-going compliance trends and developments. Reports new developments to department.
• Performs other duties as assigned.

• Work requires knowledge of revenue cycle process and hospital/medical billing
• Work requires understanding of components of electronic medical records.
• Work requires current knowledge of code data sets to include CPAT, HCPCS, and ICD 10.
• Work requires current knowledge of NCCI edits, and Medicare LCD/NCDs.
• Work requires computer skills; MS Office including, Word, PowerPoint, Excel, and Outlook; Windows Operating System and Internet.
• Work requires the ability to perform consistent audits of all hospital departments’ charges and chart documentation.
• Work requires the ability to perform account analysis and provide report to Audit RN to finalize a defense audit.
• Work requires the ability to complete daily resolution of all claim edits, charge discrepancy inquirIes and patient charge dispute inquires via EPIC WQs or Audit Nurse Email box.
• Work requires the ability to identify areas of opportunity for improvement and perform necessary education.
• Work requires interpersonal and communication skills, analytic and organizational skills, critical –thinking and the ability to meet deadlines

Work primarily performed in office setting. Must be able to lift five (5) pounds

This position is security-sensitive and thereby subject to the provisions of Texas Education Code §51.215. UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status. To learn more, please visit: https://jobs.utsouthwestern.edu/why-work-here/diversity-inclusion/.

2021-2022 Benefits Summary

• PPO and ACO Options
• 100% Coverage for Preventative Health No Co-Pay
• Tobacco-Free Incentives
• Generous Prescription Drug Plan
• 3 Options for Dental Coverage
• 2 Options for Vision Coverage
• Abundance of Wellness and Employee Assistance Programs

(Eligibility varies by employment status)

• The Teacher Retirement System of Texas is a defined benefit plan with 5-year vesting
• Employee Contribution Max 7.7% of salary
• Employer Contribution Match up to 7.5% of salary
• Optional Retirement Program (ORP) defined contribution plan with 1 year, 1 day vesting
• Employee Contribution Max of 6.65% of salary
• Employer Contribution Match of 8.5% of salary
• Optional Tax-Sheltered Annuity
• Optional Deferred Compensation Plan

• 15 Paid Holidays, Eligible Day 1
• 8 Hours/Month Accrued Vacation
• 8 Hours/Month Accrued Sick Leave

• On-Site Day Care
• Employee Discount Program
• Tuition Reimbursement Program
• Long-Term Disability Coverage
• Short-Term Disability Coverage
• Voluntary Group Life Coverage
• Accidental Death & Dismemberment Coverage

Why are top candidates in so many professional fields – including customer service, finance, and human resources, to name a few – choosing UT Southwestern Medical Center as a career home? Simple. They know that they will work among a team of people who bring their best every day to support a health organization that’s breaking new ground in dozens of ways. That’s what we can offer you.

It takes a lot to keep UT Southwestern at the forefront, where world-class patient care, acclaimed medical education, and innovative research breakthroughs are common occurrences. When you join us, those are the challenges you’ll share. Our organization has taken on serious commitments and responsibilities within a rapidly evolving health care system.

Change is a constant, so our work supporting this complex matrix of business and systems needs must rise to the highest level of professionalism, collaboration, and innovation. That’s true for every role across the Medical Center and represents why this can be the most challenging work of your career.