Senior Revenue Integrity Analyst

The Senior Revenue Integrity Analyst role reviews claim reimbursement to ensure accuracy to contractual guidelines and payer fee schedules across multiple Oncology practices across multiple states. Responsible for analysis, trending, system setup and corrections, and payer escalation in conjunction with practice leadership. The individual will need to have expertise in medical billing, as well as a strong understanding of the insurance reimbursement and contracting processes. This will be a remote role.

Responsibilities

• Load and/or maintain practice contracts in our insurance reimbursement tracking tool. 

• Validate contract modeling and setup opportunities as needed, in collaboration with external partners. 

• Identifyerroneous payer trends and escalate payer reimbursement issues and contracting concerns to leadership, as needed. 

• Contact payers on high dollar individual escalations or high priority payer issues. 

• Organize and coordinate individual claim resolution with practice team and other partners. 

• Work with other members of the RCM team to ensure proper resolution and timely payment. 

• Maintain a thorough understanding of HCPCS/ICD/CPT oncology coding and specific carrier requirements/knowledge. 

• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer. 

Required Qualifications

• High school diploma or equivalent required 

• Bachelor’s degree preferred 

• Minimum of 3 years of experience in insurance reimbursement and contract analysis required, preferably in an Oncology healthcare setting.

• Radiation Oncology experience a plus 

• Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid 

Essential Competencies

• Attendance is an essential job function. 

• Detailed knowledge of billing, HCPCS, CPT and ICD codes  

• Previous commercial collections experience preferred  

• Ability to work effectively with all levels of management and other colleagues, demonstrating initiative, mature judgment and customer service orientation.  

• Effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations. 

• Exceptional Multi-tasking, organizational skills and superb attention to detail.  

• Strong analytical skills 

• Skill in negotiating issues and resolving problems.  

• Excellent customer service skills. 

• Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient billing and other medical information systems. 

• Must possesshigh degree of professionalism and adaptability.