• Job Type: Officer of Administration
• Regular/Temporary: Regular
• Hours Per Week: 35
• Standard Work Schedule: 9AM-5PM, M-F
• Building: Parker Plaza
• Salary Range: $90,000.00-$100,000.00

Position Summary

Under the supervisor of the Associate Director of Revenue Cycle, the Revenue Cycle Analyst is responsible for providing strong analytical assessments, reporting, and operational support on multiple aspects of revenue cycle operations in a central business office. This position will primarily support units within the central business office that manage government, International, and various non-standard third-party accounts receivables.

Responsibilities

Operations/Technical

• Reviews and analyzes "Explanation of Benefits" (EOBs), payer correspondences to identify denials to be appealed. Perform denials analysis to reduce controllable rejections.
• Performs data extraction and manipulation using BI tools, Excel, and other query tools within practice management systems.
• Utilizes knowledge of group payer contracts, payer policies, payer plans, and member benefits to perform reimbursement analysis.
• Applies knowledge of professional billing, payer policies, medical coding, and key contractual terms in performing analysis. Relay changes in insurance policies discovered by claim denials to all pertinent stakeholders.
• Participates in training and other in-servicing sessions for end-user education within the central business office and service vendor.
• Facilitates and works payer projects to manage bulk appeals with various stakeholders and insurance carriers.
• Oversees various projects as directed by the Associate Director. Operationalizes project plan including developing and executing related communication plans. Tracking project plan progress, proactively identifying areas of resistance and outliers to escalate for mitigation, and executing mitigation plans as needed.
• Prepares presentations for various sponsors and stakeholders as needed.
• Monitors and performs analysis on work queue inventory to identify corrective actions to work queue logic including, but not limited to reviewing logic criteria and ensuring correct logic build, obtaining feedback from work queue users to understand trends and workarounds, making recommendations to improve logic build and reduce outliers and/or backlogs.
• Develops new report templates for ad-hoc and or standard monthly reports to assist with the monitoring of
• Revenue Cycle Metrics. Provides assessment of revenue cycle processes with a focus on process improvement and best practices. Monitor and analyze to compare within industry benchmarks.
• Prepares reports and formal presentations for leadership
• Assists with management of user access to various systems such as payer portals, EMR, receivables system, and bank lockboxes
• Assists management with obtaining pertinent data to support establishing and maintaining service agreements with external vendors. Facilitates auditing and processing of vendor invoices for payment.
• Assists with performance tracking of external vendor services. Assist with identifying and resolving operational issues with the delivery of services by vendors.

Strategy

• Assists unit management with a compilation of staff productivity and quality assurance statistics. Assist management by analyzing productivity and operational performance of business units through the use of key metrics and pertinent data.
• Assists the Associate Director with identifying relevant trends and opportunities. Analyze trends and key data points to maximize efficiencies within and outbound collection efforts. Identify opportunities for creating estimates and pre-payment collection effort
• Present data, analysis, and recommendations for solutions in meetings with unit management and other stakeholders.

People

• Establishes effective collaborative relationships with peers and other subject matter experts (SME) to seek resolution of issues identified through monthly monitoring of KOIs/KPIs.

Other

• Represents the CRO Management Team on committees, task forces, and workgroups. Negotiates workable compromise solutions to complex problems between the FPO, CRO, and other departments, outside vendors, etc.
• Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.
• Performs other duties and responsibilities as assigned by the Chief Revenue Cycle Office and Directors of the CRO.

Minimum Qualifications

• Bachelor's degree or equivalent in education and experience.
• 4 years of related experience with a preference for experience in physician billing and third-party payer reimbursement.
• An equivalent combination of education and experience may be considered.
• Advanced skills in using Excel and BI data applications to maneuver through large volumes of data.
• Strong verbal and written communication skills.
• Ability to work independently, follow through, and handle multiple tasks simultaneously with minimal supervision.
• Must be a motivated individual with a positive and exceptional work ethic.
• Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self-pay reimbursement concepts and overall operational impact.
• Strong knowledge of electronic billing systems for front-end and back-end functions and the willingness to learn new systems, applications, and programs.
• Advanced proficiency in data extractions (DBMS & Data Warehouse Tools) and use of business analytic applications.
• Demonstrated advanced skills in A/R management, problem assessment, and resolution and collaborative problem-solving in complex, interdisciplinary settings. Excellent analytical skills: attention to detail, critical thinking ability, decision-making, and researching skills in order to analyze a question or problem and reach a solution.
• Must successfully complete systems training requirements.

Preferred Qualifications

• Knowledge of Epic PB Resolute is preferred.
• Familiarity with data visualization tools such as Tableau or Power BI (Power Query).

Competencies

Patient Facing Competencies

Minimum Proficiency Level

Accountability & Self-Management

Level 3 - Intermediate

Adaptability to Change & Learning Agility

Level 3 - Intermediate

Communication

Level 3 - Intermediate

Customer Service & Patient-Centered

Level 3 - Intermediate

Emotional Intelligence

Level 3 - Intermediate

Problem Solving & Decision Making

Level 3 - Intermediate

Productivity & Time Management

Level 4 - Intermediate

Teamwork & Collaboration

Level 3 - Intermediate

Quality, Patient & Workplace Safety

Level 3 - Intermediate

Leadership Competencies

Minimum Proficiency Level

Business Acumen & Vision Driver

Level 2 - Basic

Performance Management

Level 1 - Introductory

Innovation & Organizational Development

Level 2 - Basic