Revenue Integrity Analyst

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

- We serve faithfully by doing what's right with a joyful heart.
- We never settle by constantly striving for better.
- We are in it together by supporting one another and those we serve.
- We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

The Revenue Integrity Analyst manages projects and service lines. They ensure system-wide charge capture activities follow Baylor Scott & White Health (BSWH) processes, policies, and State and Federal guidelines. This position develops and maintains a strong knowledge of their assigned primary service lines and key relationships. They represent their service lines, Revenue Integrity, and the broader Revenue Cycle to individual contributors and leadership.

Essential Functions of the Role

- Creates a standardized charging method for all facilities in the assigned service line(s). Partners with IS to design, build, validate, and test workflows affecting the Revenue Cycle. Gains detailed knowledge of charge capture workflow and mechanisms to support IS teams in building the required systems for expected charging outcomes.
- Manages charge capture projects and initiatives for assigned service lines. Identifies problems by evaluating business requirements and examining data. Negotiates organizational consensus and synthesizes key messages for communication to all stakeholders. Collaborates with numerous teams to support charging and billing accuracy efforts.
- Performs charge capture audits and education. Designs, creates, and conducts audits to evaluate compliance with BSWH policies, procedures, and laws related to charging practices for assigned service lines. Formulates recommendations and corrective actions based on audit findings. Compiles written audit reports detailing risks and financial impacts of deficiencies and proposes solutions for mitigation.
- Independently manages assigned responsibilities within established guidelines and processes, exercising sound judgment and escalating complex or non-routine issues as appropriate.
- Examines accounts, claims, and clinical documentation for accurate charge capture and billing. Interprets medical records to validate charges. Provides feedback and education based on findings.
- Ensures the accuracy of the Charge Description Master (CDM). Evaluates critical data elements in the CDM. Ensures adherence to CMS, AMA, third-party payor, and other guidelines. Validates all changes for data integrity.
- Reviews, interprets, and implements coding and billing changes for the assigned service line(s) related to CPT updates. Evaluates clinical processes to determine necessary changes for updated coding and billing regulations.
- Provides charge reconciliation education to assigned service lines and clinical departments. Performs frequent audits to ensure department compliance.
- Helps new departments, facilities, services, workflows, or methodologies succeed by performing charge capture audits. Rounds with department leadership and key stakeholders to ensure operational success. Provides an avenue for questions and escalations.
- Performs other position appropriate duties as required in a competent, professional, and courteous manner.

Key Success Factors

- Possess exceptional verbal and written communication skills. Able to create informative, concise communications free of spelling and grammatical errors.
- Experience managing projects preferred.
- Ability to execute tasks through an organized and detailed approach.
- Have advanced Excel knowledge, including formulas, functions, and pivot tables, to analyze large data sets and draw conclusions.
- Ability to work alone and as a part of a team in a fast-paced, unpredictable, and deadline-driven environment.
- Exceptional organizational skills.
- Proficiency in researching complex questions and providing recommendations.
- Self-motivated with ability to identify and resolve issues and advance personal knowledge.
- Ability to interpret complex state and federal regulatory requirements, assess their impact on billing, reimbursement, and compliance, and take appropriate action to support accurate and compliant revenue cycle processes. Epic Hospital Billing, Professional Billing, and Chargemaster experience preferred.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
- EXPERIENCE - Less than 1 Year of Experience