PFS Regulatory Integrity Anaylst

Company Name:
Advocate Health Care
Job Title: PFS Regulatory Integrity Anaylst
Job ID Number: 25800-68929
City: Oak Brook
State: Illinois
Hours per pay period: 80 hours
Shift: Day
High School Diploma or equivalent General Education Degree (GED)
5+ years of Medicare billing experience in a hospital setting.
Solid understanding of third party payors, Medicare, Medicaid and private insurance companies.
Basic understanding of medical terminology, ICD-9 and CPT coding.
RAC experience preferred Excellent communication and organization skills.

Ability to analyze and problem solve independently. Excellent working knowledge of automated billing processes.

Orientation to detail and accuracy. Ability to multi task effectively.

Ability to work independently.

Working understanding of the Florida Shared System

Ability to read and understand medical records.

Must be able to travel to and from Shared Revenue Cycle Office (SRCO), each of the Advocate Hospitals, seminars and other Advocate sites.
Job Description:
Under the direction of the Regulatory Integrity Manager, the PFS RI Analyst is responsible monitoring denial activity associated with regulatory and prepayment audits from Government Payors such as Medicare and Medicaid.
Assures that Automated RAC denials are appealed when appropriate, and that those appeals are filed timely and accurately.
Communicates denial activity as appropriate to parties at Advocate facilities.
Collaborates with others to improve performance related to governmental regulatory claim denials.
Responsible for the complete and accurate entering of the financial data into the audit tracking database, for all audit cases and audit types.
It is the responsibility of the PFS Regulatory Analyst to operate in accordance with federal and state regulations as mandated by CMS and HIPAA, Medicare Secondary Payor and all other Medicare and other governmental payor compliance issues.

Monitor and investigate all automated RAC (RAC-A) denials as well as automated RAC denials for other governmental claims.

Monitor the FISS or other automated system(s) for Additional Development Requests (ADRs) for RAC Prepayment (RAC-P), Prepay Probe, and other regulatory audits received.

Monitor FISS for prepayment audit denials

Monitor all regulatory denials (such as) RAC, MAC, and CERT

Prepare and submit Automated RAC appeals when appropriate

Update audit tracking database with the financial outcomes for all regulatory audits that are captured

Performance of other duties as needed when appropriate

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