Operations analyst Jobs in San Bernardino, CA

Patient Accounts Operations / Systems Quality Analyst

Be a part of a world-class academic healthcare system, Company, as a Patient Accounts Operations / Systems Quality Analyst in the Rev Cycle Department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area.

In this role as a Patient Accounts Analyst, you will analyze accounts, processes and systems to find root causes of defects. Under minimal supervision, supports the Patient Account Quality Assurance activity for the Hospitals with an emphasis on ensuring that billing (focused Governmental and Non-Governmental) processes are in compliance and on operational activities for management and clerical staff (all patient account department functions). Works as primary analysts and testing support on Patient Accounting and Clinical systems module / step installations, upgrades and fixes; working with IT and operations resources. Works on projects for Patient Accounting and Clinical systems to support activities related to Medicare, Medicaid and all third party billing and collection of claims. Assists in overseeing the patient accounting and revenue cycle areas including charge entries, bill holds, coding initiatives, forms and data capture, etc. Reviews and makes recommendations on patient account and revenue cycle procedures / policies as they pertain to quality assurance. Is involved with external patient accounting audits, gathers and interprets government, state and private payer regulations. Reviews hospital enrollment statuses and reviews admission, billing and collection practices as appropriate. Assists with analysis of, tracking of and review of all internal / external audit requests. Serves as liaison to other hospital departments regarding policy and procedure interpretation as it relates to efficient Medicare, Medicaid, dual eligibility, State and federal HMO's and all third party regulations, reimbursement and ensures patient accounts processes and procedures are in place and adhered to. Works with Revenue Cycle Management in assigning the appropriate billing codes and initiates changes to facilitate the all billing processes.

Essential Job Functions

• Participates in all system upgrades and changes that relate to Patient Accounts. Works as primary analysts and testing support on Patient Accounting and Clinical systems module / step installations, upgrades and fixes; working with IT and operations resources. Assists in overseeing development, installation and / or implementation of new computer based systems, and changes to existing systems as they affect patient accounting services. Assists in problem solving on all internal and external systems. i.e. 3M, Centricity, Intercept, Medicare, Passport, Ecare, Craneware, Artiva, etc. Responds to internal areas questions, and provides assistance related to systems. Coordinates and takes the lead on special projects.
• Maintains bill hold edits from current NEBO / ECARE electronic billing system, ensures claims are billed correctly (according to government billing rules), implements and works with IT staff and tests new bill holds, tests billing requirements and / or changes from governmental agencies to ensure that the changes made by IT are working prior to installation into the production environment in Centricity. Assists in overseeing the patient accounting and revenue cycle areas including charge entries, bill holds, coding initiatives, forms and data capture, etc.
• Assists with the interpretation and implements regulatory issues related to billing / collection, and clinical trials. Must be familiar with all governmental agencies related to billing and collections. Remains familiar with and complies with all federal and state health care laws, regulations, and rules including applicable Medicare, Medicaid and Private payer billing requirements. Remains on top of all new billing regulations, especially Medicare billing changes and communicate changes to appropriate areas. Reports any possible noncompliance with applicable laws to immediate manager or hospital compliance hotline. Acts as a liaison between finance, HIM, and compliance office as needed.
• Audits Patient Accounts System master files; such as charge master and insurance master, etc.
• Reviews and assists in the development and audit of patient accounts and revenue cycle related policies and procedures. Assists Managers and Directors in developing and documenting policies / procedures. Reviews and reports on corrections to non-covered billing processes, credit balance process, patient correspondence, system generated letters and statements, and staff generated communications, to ensure the highest quality product is submitted to adhere to policies governing patient confidentiality. Performs monthly A.R. Maintenance on Accounts Receivable by requesting and reviewing approved write-off criteria. Works with other departments within the Hospitals and with external organizations to assure that financial issues and decisions on policy / procedure for financial workflows are followed.
• Reviews billing, denial, rejection, and delays trends. Review and Approve Late Charge entry requests. Creates new finance accounts, process adjustments to write off the charges on a monthly basis. Processes charge overrides of pro-fee charges on Medicaid accounts for services performed by Assistant Physician Nurses (APNs). Performs manual coding of claims and follow-up on all Medicare Inpatients receiving Factor Drugs to receive additional add-on payments from Medicare. Assists billers, hospital administrators, pre-billing and clinic staff in resolving complex accounts and patient problems that may result in nonpayment of hospital bills. Assists the Revenue Cycle Management Department with the correct assignment of revenue codes and CPT / HCPCS codes to ensure claims are accurately presented to Medicare and other third party payers.
• Serves as liaison to other hospital departments regarding policy and procedure interpretation as it relates to efficient Medicare, Medicaid, dual eligibility, State and federal HMO's and all third party regulations, reimbursement and ensures patient accounts processes and procedures are in place and adhered to. Participates in committees and forums as a representative of the Hospitals on financial issues. Assists in the selection and ongoing monitoring of external agencies working on behalf of the Hospitals.

Required Qualifications

Position Details

Why Join Us

We've been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment with patients and with each other. We're in this together : working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you'd like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we're doing work that really matters. Join us. Bring your passion.

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UChicago Medicine is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Must comply with UChicago Medicine's COVID-19 Vaccination requirement as a condition of employment. If you've already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.