at MaineHealth in Scarborough, Maine, United States
Job Description
Summary
Position Summary
This position 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 Maine Health organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.
Under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst II plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and three (3) to five (5) years' of experience within the revenue cycle. Experience above minimum requirement will be considered in lieu of education.
License/Certifications: Applicable professional certification through AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC) or Pharmacy Technician (CPhT, PTCB).
Experience: Three (3) to five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. EPIC HB/PB experience preferred.
Proficiencies: Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, RAs and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical -thinking and the ability to meet deadlines while influencing, but not directly managing the work of others. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
Additional Information
MaineHealth was ranked one of America's Best Large Employers in 2022 by Forbes!
MaineHealth is a not-for-profit integrated health system whose vision is, "Working together so our communities are the healthiest in America." MaineHealth consists of nine local health systems, a comprehensive behavioral health care network, diagnostic services, home health agencies, and 1,700 employed clinicians working together through the MaineHealth Medical Group. With approximately 22,000 care team members, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. Learn more about our system at
At MaineHealth, we offer benefits that support an individual's needs for today and flexibility to plan for tomorrow. Our packages include health and dental insurances, paid parental leave, retirement program, generous paid time off, and much more! Our comprehensive array of benefits are competitive, affordable, and include choices that meet specific, but ever changing, needs.
With a career at any of the MaineHealth locations, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the neighborhoods that surround it. We are deeply invested in the well-being of our communities and care team members. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Join us, and your abilities will be challenged and enhanced as you take your career to a new level.
Additional Information MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org
MaineHealth values 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 status.
