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In May 2022, we proudly announced our new brand: ECU Health.

Rebranding changes continue to unfold on our Careers website as we update the Talent Acquisition portals housed within. Throughout this process and into the future we remain committed to the communities we proudly serve. We’re excited for what it means for the future of health care in eastern North Carolina and for the incredible team members who are helping to make it happen.

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Revenue Integrity Analyst

Job ID: 970101
Facility: ECU Health
Dept: Revenue Integrity
Location: Greenville, NC
FT/PT: Full-Time
Shift: Not Applicable
Reg/Temp: Regular
Date Posted: May 20, 2024

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Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

Maintain expertise on Third Party Billing Regulations and Requirements to ensure EPIC EAP remains in compliance with applicable regulations for ECU Health entities.

Develops tools to provide education and communication to Revenue Producing Departments

Resolves EPIC EAP related billing issues that are preventing claims to be submitted for payment.

Analyzes reimbursement and charge data for service line analysis.

Develops and maintains understanding of systems involved in the updating of charges as well as PC related skills.

Works with Information Systems for the regular updates to the EAP.

Responsibilities

1. Develops action plans to achieve goals for processes and special projects as it relates to the EPIC EAP for all ECU Health entities. Examples of goals would be charge request turnaround time, annual coding updates and rate increases. Ensures that workflow and processes adhere to developed goals and informs supervisor of any obstacles.

Remain up-to-date on Third Party Billing Regulations by reviewing regulatory/contractual updates and communication.  Utilizes this information in the decision making process of implementing accurate and compliant updates to the CDM for all ECU Health entities.  Changes that are not accurate or compliant can cause billing errors that result in a payback or in the cases of investigative audits by the OIG or other agencies, financial damages.

Remain up-to-date on EPIC or other related EAP software functionality. Demonstrates the ability to understand the hospital billing system processes and related clinical systems so that charges are correctly updated in all systems. Must be able to use Excel or other necessary software to manipulate, summarize, and analyze data.

Reviews EPIC Dashboards to ensure all charges are captured in a timely manner, are in compliance with state and Federal guidelines, and are achieved within the 5 day window after patient discharge.

2.   Ensures that multiple clinical departments remain informed regarding regulatory changes that will affect charging processes. Researches, summarizes and develops changes so that information is communicated to clinical areas through meetings, conference calls, e-mails, etc.

Must be able to field questions from across the entire system regarding the appropriateness of charging for services and products. Must be able to function independently in completing assigned projects.  Communication on charging issues must be provided in a professional and customer service oriented manner.

Analyzes coding and charging data to facilitate the gathering and reporting of financial data for service line profitability, charge analysis and other special projects.

Review charge requests for all facilities for accuracy, assigns service codes so that all codes are consistent across the system to maximize efficiency and compliance in the EAP.

Coordinates changes across multiple departments to include Information Systems, Materials and Finance.

Analyze departmental charging for additional revenue opportunities and work with the hospital operations to implement these additions to maximize our financial performance.

3.   Processes and communicates rate changes for all entities for annual rate increase. Receives requested price changes from Financial Planning or CFO of hospital and reviews changes for accuracy and consistency.

Provides all rate increase information to Information Systems for actual implementation of changes. Ensures that all changes are made in a timely and accurate manner prior the start of the new fiscal year so that there is no revenue lost that would cause a negative financial impact to ECU Health entities.

Communicates all changes to Blue Cross Blue Shield and fields questions regarding price changes. After implementation investigates any revenue variance from projected.

Develop and provide education on new or difficult charging issues to ensure maximum revenue and compliance with all regulations.

Run various reports on a weekly basis to ensure compliance in charging and billing. Make corrections and provides the necessary education to prevent these errors from reoccurring.

Minimum Requirements

Bachelor's Degree or higher in Business, Health Information Mgmt., Health Administration or related.

Two year RN or RHIT degree may be substituted for four year degree.

Minimum 2 years of financial and/or business experience gained in a healthcare setting required.  Billing, charging, and/or coding experience in a hospital setting is a plus.

Other Information

  • Revenue Integrity/CDM experience preferred.
  • Epic experience preferred.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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