Healthcare Data Integrity Analyst - Hybrid
Description
Healthcare Data Integrity Analyst
Hiring Range: $29.58 - $36.97 per hour
This is a remote position, but requires in-person attendance for monthly team meetings. Kitsap County residents are encouraged to apply.
Benefits:
- Comprehensive and generous health, dental and vision benefits
- Up to 19 days of PTO, 2 mental health days and 9 paid holidays your first year (pro-rated for part-time)
- Company-paid life insurance, short-term disability, and long-term disability
- Student loan payment assistance and extensive training
- An incredible team approach that is dynamic and collaborative
General Summary of Duties: The Healthcare Data Integrity Analyst researches, develops, prepares, analyzes, and maintains agency-wide computer information systems. When needed, he or she assists in managing the department’s tasks, workflows, and provides technical assistance and training to agency personnel in the use of computer software.
The Healthcare Data Integrity Analyst engages with end users in EHR project development design specifications and coordinates implementation with the development team. They coordinate with the systems analyst manager to develop projects in our project software and task assignments.
Supervisory Responsibilities: None
Major Responsibilities/Tasks:
- Supply financial application enhancements and modifications as needed to meet internal or external requirements.
- Evaluate coding and billing practices to ensure that appropriate billing and coding practices are being utilized.
- Present findings and feedback in a positive, helpful manner to appropriate parties, and moreover, they should provide pertinent education or guidance to improve the billing and coding procedures.
- Responsible for being current and knowledgeable of billing, coding, and documentation guidelines from the Centers for Medicare and Medicaid Services and other payors.
- Develops, implements, and ongoing maintenance of Electronic Data Interchange (EDI) transactions, including HIPAA 837 claim, 835 remit, 270/271 eligibility inquiry and response, 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions.
- Ensure exchanges are smooth between healthcare systems and external partners. In addition, the researcher will ensure that the appropriate verification, authorization, and HIPAA transaction protocols are in place.
- Assist with configuration, testing, implementation, and monitoring project plans to determine the readiness of conducting the 837i, 837p, 270/271, 835, etc.
- Analyze and understanding implementation guidelines/specifications for both batch and real time of all HIPAA, CMS Forms (specifically UB-04 and CMS-1500).
- Troubleshoot issues related to EDI/HIPAA transactions and coordinate resolution with IS Team, EHR Systems (Credible preferred) and the payers.
- Knowledgeable with 837 electronic claims submission and 835 electronic remittance transactions.
- Maintain comprehensive knowledge in advanced report design, including Dashboards with a primary focus on documentation compliance and KPIs. Use of Data Analytics to query, analyze trends, and report meaningful information to substantiate and aid in the provision of quality care. Requires competency in a multitude of platforms, Crystal Reports, Power BI, Credible BI (preferred), Excel, SQL Reporting Services (SSRS) and Management Studio
- Maintain comprehensive knowledge of the SERI, Washington State Data Dictionary, and any other state and federal mandates related to the Electronic Health Record, data, and reporting to maintain and configure the software, keeping workflow in compliance with guidelines.
- Contribute to the efficient operation of all units supported by applying systems analysis techniques to application workflow development. Analyze and collaborate with end users to recommend technical optimization. Research, define, and document systems as needed and design specifications for application development. Supply application enhancements and modifications as needed to meet internal or external requirements.
- Project management and documentation of all System Changes and New Configurations and delegation of duties.
- Provide accurate documentation and operator training as required during application implementation or enhancement, as well as ongoing technical support when required.
- Maintain knowledge of IS-supported software, be familiar with operations utilizing the software, and provide technical support. Trouble-shoot software problems and communicate with vendors regarding application needs, problems, and resolutions.
- Provide technical assistance in maintenance tasks, system security, and file management on the KMHS network.
- Provide technical support in purchasing and using new computer hardware and software. Test and evaluate new software packages.
- Provide backup coverage for the I.S. Manager as requested.
- In addition to the above, any other responsibilities appropriate to the position and not specifically listed in the job description.
Minimum Qualifications:
EDUCATION: Associate's Degree in a computer-related field OR a combination of education and experience.
EXPERIENCE: Experienced (minimum 3 years of job-related experience)
- Must have comprehensive experience in professional, outpatient, and inpatient facility coding from a coding, billing, and compliance perspective.
- The individual should be well-versed in billing integrity monitoring by the Washington Service Encounter Reporting Instruction (SERI) guide.
Preferred Qualifications:
EDUCATION: Bachelor’s Degree in a computer-related field.
EXPERIENCE: Specialist (minimum 5 years of job-related experience)
Experience in Credible, Electronic Health Record administration, Crystal Reports, Credible BI Reporting, Power BI Reporting, Excel, Credible Ad-Hoc Reporting, Credible Advanced Search Reporting, and SQL Reporting Services (SSRS).
Experience in the following subjects is desirable: database management, Windows Server, Application/Terminal Server environment, Microsoft Office applications, database managers, MS Access, SQL. Prefer experience on both mainframe computers and PC's.
Performance Requirements:
KNOWLEDGE:
- Working knowledge of HIPAA/HITECH.
SKILLS:
- Must possess excellent written and verbal communication skills.
- Need superior customer service skills, being able to work effectively with a variety of people in all departments to determine their problems and find solutions.
ABILITIES:
Demonstrated ability to:
1. Work on projects independently, process varied information, reach appropriate decisions, and be creative.
2. Work well in a continually changing environment with high stress and pressure being the norm.
Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.
Work Environment: Frequent mobility and/or sitting required for extended periods.
Mental/Physical Requirements: While performing the job duties, the employee is required to walk, sit, use hands and fingers, reach with arms, talk, or listen.
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER