Charge Integrity Analyst

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

10/1/2018

Entity:

Wisconsin

Job Code:

440063

Job Title:

Charge Integrity Analyst

FLSA Exemption Status:

Exempt

Management Level:

Individual Contributor

JOB SUMMARY

Under the general direction of the Manager of Charge Capture, the Charge Integrity Analyst is responsible for the management of various operational charge capture functions.

The Analyst will serve as the primary liaison between the revenue cycle and clinical leaders throughout UW Health. Responsibilities of this position will include assisting clinical leadership and staff with charge reconciliation, identifying denial and missed charge trends, charge reporting, and charge troubleshooting. The incumbent will need a comprehensive understanding of charging processes, projects assigned, and the business needs being addressed.

The Charge Integrity Analyst is responsible for educating revenue center departments on best practices to review and reconcile their daily charge capture processes. This includes documentation, reporting, training, and implementation of proposed charge practices or changes consistent with policy and established change management practices, making certain that all stakeholders understand and are adequately prepared to move forward with those processes and changes. In addition, this individual will develop, produce, validate and distribute standard charge-related reports and ad-hoc reports as needed.

The individual must work closely with a vast array of clinical, financial, and IT leadership and staff of UW Health to ensure that coding, charging, charge reporting, and reconciliation processes function smoothly. Proper charge capture is critical to achieving fair billing practices, meeting third party billing requirements, receiving appropriate reimbursement for services rendered, reaching revenue targets, and enhancing reporting capabilities.

This position represents UW Health and the Revenue Cycle team by adhering and upholding the UW Health Mission, Vision, and Values, and UW Health Service Performance Standards in providing the highest quality service. They will support their co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to the needs of our customers.

ESSENTIAL DUTIES

•

Identify, coordinate, prioritize and implement changes to charging, reconciliation and reporting and oversee the development, testing, implementation and maintenance of UW Health charging practices

•

Develop, produce, validate and distribute standard charge-related reports and ad-hoc reports as needed.

•

Monitor charge capture work queues and email requests to ensure accounts are worked/corrected in a timely manner

•

Communicate charge related procedure changes to clinical users, the revenue cycle, and other effected groups

•

Identify any inaccurate patterns in charging and work with either the departments or technical team to resolve

•

Provide direction and suggestions for improvement as needed

•

Participate/schedule discussions related to work-flow concerns with department managers, business office users, coding, information systems, and cost accounting teams as needed

•

Work with Clinical Systems Analysts to coordinate the review of all charge requests or changes with coding, billing, and cost accounting to ensure codes follow internal and national compliance standards

•

Implement new policies and procedures as needed to maximize reimbursement for all services rendered in compliance with established commercial and government payer guidelines.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Clinical

(Select all that apply)

JOB REQUIREMENTS

Associate's Degree

in Health Care, Business, or a related field

Required

Two (2) years of experience in charge capture, coding or a hospital business office may be considered in lieu of the Associate degree in addition to the experience below.

Required

Bachelor's Degree

in Health Care, Business, or a related field

Preferred

3 years

of experience in a health care business, coding, or clinical setting

Required

5 years

 of coding or charge capture experience in a hospital business office for a large, complex health care environment including experience in an academic medical center.

Preferred

Experience and/or Certification with Medical Coding

Preferred

Certification with Epic Revenue Cycle Modules

Preferred

Certification as a Medical Coder

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Demonstrates a clear understanding of charging practices in an academic medical center.

•

Ability to make good judgments in demanding situations

•

Ability to react to frequent changes in duties and volume of work and manage multiple concurrent activities

•

Ability to logically organize details

•

Responsible for medium to large scale projects involving multiple resources and spanning many months from start to finish

•

Effective organizational, planning, scheduling and project management abilities

•

Effective leadership skills.

•

Ability to implement change in a positive, sensitive, and forward-thinking manner

•

Planning and problem solving

•

Developing goals and objectives, and establishing priorities

•

Inspires confidence, Good judgment and ability to act decisively at the right time

•

Self-starter with a willingness to try new ideas

•

Positive, can-do attitude coupled with a sense of urgency

•

Effective communication skills both in written and verbal presentation with a communication style that is open and fosters trust, credibility and understanding.

•

Ability to analyze data and workflows to develop and analyze options, recommend solutions, and solve complex problems and issues

•

Strong customer service and human relations abilities

•

Ability to effect collaborative alliances and promote teamwork

•

Ability to insure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders

•

Ability to use various computer applications is preferred including EPIC and Microsoft Office

•

Broad knowledge of health care, coding and/or hospital business office practices and principles: general accounting principles and Coding, CPT and HCPCS

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

☐

Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.