13 days old

Revenue Integrity Analyst

The Nemours Foundation
Orlando, FL 32801
  • Job Code

As one of the nations leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children even those who may never enter our doors through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.

Nemours is seeking a Revenue Integrity Analyst (Full-Time), to join our Nemours Children's Hospital team in Orlando, Florida.

Located in Orlando, Fla., Nemours Childrens Hospital is the newest addition to the Nemours integrated healthcare system. Our 100-bed pediatric hospital also features the areas only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region. A hospital designed by families for families, Nemours Childrens Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond. In keeping with our goal of bringing Nemours care into the communities we serve, we also provide specialty outpatient care in several clinics located throughout the region.

Maximizes charge efficiency through (a) monitoring revenue cycle processes and staff functions; (b) supporting Nemours Childrens Hospital and Nemours Specialty Care Services-Orlando revenue capture integrity by evaluating the accuracy of charge capture and billing functions and staying apprised of payor and/or regulatory updates; (c) assisting in the design and implementation of charge capture/billing workflow improvements. Maximizes reimbursements through (a) monitoring and reporting on claim denials and zero payments; (b) communicating with key stakeholders actions steps to prevent denials and zero payments; (c) work collaboratively with central business office to assure appropriate appeals of denials and/or coding adjustments to prevent denials.

  • Leads the development and refinement of charge capture workflows.
  • Leads the development, fine tuning, and auditing of charge capture reconciliation.
  • Develops and maintains dashboards and reports on charge capture and charge capture reconciliation.
  • Monitors, reports, and takes action on trends in claim denials and zero payments.
  • Recommends front end staff education and communication for denial prevention.
  • Develops and maintains dashboard and reports on denial and zero payment management and prevention.
  • Prepares summaries that pinpoint root causes of charge and billing errors.
  • Participates in Charge Master (CDM) and Physician fee schedule maintenance efforts.
  • Additional miscellaneous duties and responsibilities, as may be assigned.

Job Requirements

  • Bachelor's Degree required.
  • Minimum of three (3) to five (5) years' experience required.
  • Certified Professional Coder (CPC) preferred.

  • High level analytics skills, Revenue cycle/revenue integrity experience, understanding of medical coding required.

  • Billing and coding experience, and experience with Epic are considered a plus but are not required.

  • Strong Excel skills. Experience in using business intelligence tools.

Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique Bridge to a Healthy Future pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.

Posted: 2019-11-24 Expires: 2019-12-23
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Revenue Integrity Analyst

The Nemours Foundation
Orlando, FL 32801

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