Scheduled Weekly Hours:
40Emplify Health is looking to hire three Revenue Integrity Analysts to join our team!
Responsible for identifying opportunities or problems, process improvements and other system changes to enhance revenue cycle performance. This role will have ongoing interactions with clinical leadership, revenue cycle staff, Finance, and IT teams. The analyst works closely with revenue cycle departments to ensure that clinical departments are informed regarding regulatory changes that affect charging processes. This position is essential in collaborating with clinical areas on charge reconciliation. Must demonstrate in-depth knowledge of CPT, HCPCS, ICD-10, as well as the current local payer policies for coding, billing, and claims processing.
Major Responsibilities Include:
Researches and analyzes both professional (PB) and Facility (HB) claims prior to new clinical services being added to ensure the appropriate reimbursement of claims. This includes all payors; to see that government regulated billing rules and payer policies are being reinforced.
Collaborates with Clinical Operation Directors and Clinical leaders to perform charge reconciliation to ensure performed visits, procedures, and tests are appropriately billed.
Collaborates with Clinical Operation Directors and Clinical leaders to create mitigation plans for charges that are not entered in a timely fashion to ensure we are not at risk for revenue loss.
Interprets existing revenue cycle policies and operating practices to make recommendations for improvement.
Demonstrates in depth knowledge and technical expertise in CPT, HCPCS, ICD-10, as well as current payer policies for coding, billing and claims processing, and provider-based billing rules.
Serves as the point of contact for complicated billing scenarios to establish proper process(es) to get the claim filed.
Facilitate multi-department billing steering committee.
Oversees and helps maintain the Revenue Guardian Edits in Epic.
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 expected window after patient discharge.
Identifies and works with Information Systems to rectify any claims data transmissions issues as they arise and track any changes.
Creates, generates, and maintains ad hoc reports proactively and as requested on various transactions to ensure consistency on claims submissions and to direct chargemaster analyst as needed to update clinical charge capture in Epic.
Maintains extensive knowledge of current EHR technical and professional billing software modules and how it relates to all payer processes.
Collaborates closely with all Revenue Cycle leaders on processes, procedures, and defining improved workflows for billing and reimbursement practices and appropriate claims submission.
Collaborates with Compliance on governmental regulated billing rules and policies to ensure new services are set up appropriately.
What's Available:
Fulltime, 80 hours biweekly (1.0 FTE)
Monday-Friday core business hours
Remote work options for residents in WI, MN, or IA only, with occasional need to work onsite for support initiatives
An Ideal Candidate Will Have:
Education: Bachelor’s degree in Business, Healthcare Administration, Finance, or related field preferred; equivalent relevant experience may be considered in lieu of degree.
Experience: Minimum 4 years in healthcare plus experience with clinic/hospital billing systems
Certifications: Certification from a recognized professional coding or health information organization, such as AAPC or AHIMA.
Analytical Thinking: Ability to interpret complex data and provide actionable insights.
Communication: Strong verbal and written communication skills; comfortable presenting to executive leadership.
Adaptability: Thrives in a dynamic environment with evolving regulations and priorities.
Problem-Solving: Proactively identifies issues and develops innovative solutions.
Attention to Detail: Ensures accuracy in charge capture, compliance, and financial reporting.
In addition to this important work, we offer a competitive total reward package:
Benefits: In addition to medical and dental, we have pet insurance and a substantial contribution to retirement
Work/life balance: 24/7 Employee Assistance Program for employees and their families, generous PTO and paid holidays
Professional Development: Tuition Invest Program totaling up to $3k per year, access to a catalogue of hundreds of internal courses, corporate incubator, Career Development Center
DEI: 12 months of Celebration to include monthly educational events
If you are looking to be a part of a stable and mission driven organization, we welcome you to apply!
Emplify Health is comprised of two of the Midwest’s most respected healthcare systems, Bellin Health and Gundersen Health System. Once neighbors, we are now partners, united in our mission to provide exceptional care to our communities. As a not-for-profit, patient-centered healthcare network, we have headquarters in Green Bay and La Crosse, Wisconsin. Our extensive network includes 11 hospitals and more than 100 clinics, serving 67 cities and rural communities across Wisconsin, Iowa, Minnesota and Michigan’s Upper Peninsula. With over 4,500 dedicated nurses and providers, we are committed to delivering primary, specialty and emergency care, along with innovative medical education programs. Join us in making a meaningful difference in the lives of our patients and communities.
If you need assistance with any portion of the application or have questions about the position, please contact HR-Recruitment@gundersenhealth.org or call 608-775-0267.
We inspire your best life by relentlessly caring, learning and innovating. This is our purpose. Together with our values — belonging, respect, excellence, accountability, teamwork and humility — our pillars set our foundation and our future.
Equal Opportunity Employer