Revenue Cycle Management Analyst III

The Revenue Cycle Management Analyst III, supports revenue cycle operations to ensure efficient workflows, management and monitoring of revenue, charges, and revenue cycle internal and external customers to ensure established goals are met while adhering to federal and state regulations, policies of external payers, coding rules and guidelines. Exercise independent decisions using analytical and problem-solving skills. Provides critical analytical and negotiation support with respect to third party payer reimbursement contracts. Works closely with the analysts in the other Revenue Cycle Management Departments to ensure effective workflow and process. Maintains strong working knowledge of operational policies and procedures related to accounts receivable management as well. Responsible for evaluating, recommending and assisting with implementation of systems solutions to enhance the automation of accounts receivable management. Performs audits designed to ensure integrity, quality and control over the billing processes. Assists with training and education on the information systems functionality and billing and coding practices.

The Analyst III works independently, manages multiple priorities, and demonstrates strong analytical and customer service skills. This position requires the ability to communicate complex information to front-line staff, department leaders, and executives while maintaining professionalism and accuracy.

This position is a technical resource, point of contact, and key participant from RCM to develop, test, train, implement and maintains the software associated with departmental functions, including conversions and upgrades. Assists with planning, execution and finalizing projects and utilizes project management tools, process and methodologies within budget and deadlines. Works independently on implementations and A / R systems development to accommodate the addition of key systems service lines. Responsible for planning, developing, training, implementation, and evaluation of information systems to support ongoing operations and ensure development, evaluation, and ongoing support for all components of Revenue Cycle.

This position is necessary to ensure the accurate flow of data and communication regarding ambulatory revenue. This positions works to ensure financial systems and report systems are coordinated relative to data quality, efficiency and data integrity.

• Coordinates with other departments including finance, decision support, business office, etc., to develop and generate reporting templates for monitoring and troubleshooting revenue performance.
• Assist in development and maintenance of revenue cycle reports, dashboards, and key performance indicators (KPI).
• May work collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends and is able to impart this knowledge to provide and other health team members.
• Support revenue cycle staff and supports revenue cycle teams as needed.
• Works with managed care and reimbursement departments to respond to strategic initiatives to optimize patient revenue capture.
• Review payments for accuracy from contracted payers and management of appeals process with each assigned payer, in both the hospital and clinic setting.
• Performs contract and reimbursement variance analysis.
• Performs related administrative duties to ensure the effectiveness and optimum maintenance of the applications.
• Supports management of projects and workflows reengineering.
• Runs, reviews, interprets, analyzes and validates Revenue Cycle reports.
• Possesses the ability to run Revenue Cycle and operations reports in order to answer questions from department / practice managers, physicians, and other Revenue Cycle stakeholders.
• Takes an active role in new service research and assessment.
• Assists in quantifying audit outcomes, including revenue realized.
• Plays a key role in the creation of training manuals and job aids for respective area(s) of expertise.
• Develops, recommends, and implements new programs and projects as directed by the Revenue Cycle leadership team.
• Researches, works with large sets of data, reviews, interprets, and follows all relevant policies, procedures, regulations, guidelines and laws and attend mandatory training.
• Participates in regularly scheduled department meetings, as well as training seminars or sessions as assigned.
• Plans, organizes and prioritizes workload and processes information at a speed necessary for successful job performance.
• Adhere to the department's rules, guidelines, and procedures for lunch and break times, requesting time-off and changes in shift assignment.
• Is thoroughly familiar with the hospitals facility-wide policy and procedures manuals, the department's policy and procedure manual and the facility's fire and safety, as well as emergency preparedness processes and procedures.
• Communicates in a calm, courteous, and professional manner with co-workers, outside organizations, representatives, or business entities.
• Other duties as assigned.
• Maintains a strong working knowledge of all departmental systems, policies, procedures and their impact on other departments.

Education : Bachelor's degree in healthcare administration, computer sciences / software development, finance / business, math, or other degree requiring complex data analysis from an accredited university or college; or, in lieu of degree in one of these specified majors, a bachelor's degree in any major plus 3 years' directly related experience in revenue cycle reporting or healthcare finance reporting and analytics.

Licensure : An HFMA Certified Revenue Cycle Rep. (CRCR) certification must be obtained within nine months of hire date.

Experience : Experience with database reporting and interfaces required.

Skills : Strong organizational and meeting facilitation skills. Ability to read and interpret regulatory information related to healthcare finance and revenue cycle. Proficient in SQL preferred. MS office applications, especially Excel, PowerPoint, Word, Access proficiency required. Knowledge of internet and government websites required. Ability to communicate effectively in writing for policies, procedures, external communications and internal communications. Ability to work effectively with a variety of personnel with varied backgrounds, education and skills, in a team environment. Ability to effectively manage multiple priorities.