Revenue Integrity Analyst

at MaineHealth in Scarborough, Maine, United States

Job Description


Fully Remote Position

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 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.

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 five or more (5+) years' of experience within the revenue cycle and coding.

Certification: Applicable professional certification through AHIMA (RHIA, RHIT,CCS) or AAPC (COC, CPC), Pharmacy Technician CPhT, or Nursing credential (RN).

Experience: Five (5) or more years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management. EPIC HB/PB experience preferred.

Proficiencies: Extensive knowledge of revenue cycle processes and hospital/ medical billing to include CDM, UB, RAs and 1500. Extensive knowledge of code data sets to include CPT, HCPCS, and ICD 10. Extensive knowledge of NCCI edits, and Medicare LCD/NCDs. Extensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Extensive working knowledge of health care 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.

Abilities: Requires the 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. Must 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.
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... For full info follow application link.

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.

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Job Posting: 939215

Posted On: Jun 05, 2023

Updated On: Jul 06, 2023

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