Revenue Integrity Analyst III
Maine Medical Center
Full Time, Days
Maine Medical Center is seeking a Revenue Integrity Analyst III in Scarborough. Under the direction of the Director of Revenue
Integrity, the Revenue Integrity Analyst III plays an important role in a
high-profile group tasked with improving revenue results. This position is
integral to the Revenue Integrity Team to assist in ensuring patient services
are accurately charged, appropriately coded, supported by clinical documentation
and that the related revenue is recorded in the proper department. In turn,
this promotes revenue enhancement and compliance with laws and regulations with
feedback and education to the hospital departments as needed.
This position is responsible for assisting Revenue Cycle
Services, Coding, Clinical Documentation Improvement (CDI), and other
departments with resolution of billing issues and/or denials requiring clinical
expertise, participating in external audit requests, and special projects as
needed. This position also serves as an audit outcome educator with clinical
staff in clinic and department settings.
The Revenue Integrity Analyst III contributes and supports
Revenue Integrity’s mission towards creating a multidisciplinary revenue integrity
team to strengthen the interface between clinical departments and charge
improvement process. It is a holistic approach that guides the MaineHealth
organization toward achieving operational efficiency, complete regulatory
compliance, and total reimbursement.
- · Technical or Bachelor’s degree preferred in
healthcare, finance, health information or closely related healthcare field.
Applicable professional certification through
AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC) or Pharmacy Technician (CPhT).
Seven years’ experience in the hospital setting,
healthcare industry or coding with a focus in one or more of the following
areas: coding, contract management, denials/appeals, compliance,
authorizations, care management, utilization review and auditing; Epic HB/PB
Knowledge of revenue cycle processes and
hospital/medical billing to include CDM, UB04, Remittance Advice (RAs), Federal
Register(s), CMS Manual, Transmittals, commercial policies, and CMS 1500.
Knowledge of code data sets to include CPT,
HCPCS, and ICD 10.
Extensive knowledge of NCCI edits, and Medicare
Extensive understanding of reimbursement
theories to include DRG, OPPS, HCC and managed care.
Extensive working knowledge of healthcare
compliance. Extensive understanding of medical terminology, anatomy and
physiology along with clinic department activities.
Capacity to review, analyze and interpret
managed care contracts, billing guidelines, and state and federal regulations
along with facilitating to all member entities.
Ability to work with and interpret detailed
medical record documents and communicate effectively with physicians, nursing
staff, leadership and other billing personnel.
Ability to manage large complex projects
assignments, investigate, analyze and resolve issues at a high level.
Excellent communication, presentation,
organizational, analytical and problem solving skills.
Ability to approach problem solving challenges
independently, have strong attention to detail and enjoy working in a fast
paced, collaborative team based environment.
Computer skills – MS Office including Word,
PowerPoint, Excel and Outlook; Windows operating system and Internet.
To apply, please click
here or visit www.careersatmainehealth.org.
About Maine Medical Center
Maine Medical Center is a complete healthcare
resource for the people of greater Portland, the entire state of Maine and
Northern New England. With a history dating back to 1864, Maine Medical Center
is the state’s largest medical center and the flagship facility of MaineHealth,
with 637 beds and more than 7,000 employees. In addition, we have achieved
Magnet™ status in recognition of our commitment to the highest standards of
nursing excellence. Maine Medical Center’s unique role as both a community
hospital and a referral center requires an unparalleled depth and breadth of
services, including the state’s only medical school, through a partnership with
Tufts University School of Medicine, and a world-class biomedical research
center, the Maine Medical Center Research Institute.
Inside and out, you’ll find what you’re looking
for when you join Maine Medical Center. As the largest hospital in northern New
England, MMC is committed to helping you grow professionally throughout your
career. From tuition assistance and scholarships, to ongoing education,
leadership training, mentoring and promotion opportunities, we offer the
resources you need to achieve your career goals.
diversity and is an Equal Opportunity/Affirmative Action employer. Federal and
state laws prohibit discrimination in employment because of race, color,
national origin, religion, age, sex, sexual orientation, disability or veteran