Revenue Cycle Management Analyst

Overview

The Revenue Cycle Management Analyst is responsible for working collaboratively with the billing staff and Assistant Director of the analysis of all payer denials, audits and reconsideration requests. Coordinates daily activities of the denial management team providing input for the system and / or workflow improvements. Maintains working knowledge of the Revenue Cycle, including Governmental Reimbursement, Managed Care Contracting & Analysis and the performance of the Business Office & Registration areas. Responsible for completion of payer appeals and reconsideration correspondence, creates payer denial trend reports. Collaborates with other departments such as HIM, Outcomes Management / Utilization Review and Reimbursement / Finance as needed.

Responsibilities

Understands all revenue cycle processes across FirstHealth entities (e.g., Pre-Services, Registration, Charge Entry, Coding, Billing, Collections, Denials).

Compiles and organizes information for presentation to management with analysis and recommendations.

Identifies and reports unusual trends; investigates and proposes improvements.

Assists in charge structure and coding reviews to ensure regulatory compliance and proper service charges.

Reviews failed claims and coordinates corrections with appropriate personnel.

Monitors CMS and payer websites for updates affecting billing and reimbursement.

Educates and shares relevant updates with staff.

Understands managed care and government reimbursement performance.

Researches root causes of denials and supports corrective action planning.

Maintains professional appearance and demeanor in all interactions with employees, applicants, and visitors.

Assists with the Hospital Financial Audit.

Supports management with special projects as needed.

Serves as a liaison between the managers, Finance, Business Office and Compliance on billing and charging issues.

Qualifications

Bachelor's degree in Accounting, Finance, or Healthcare administrative field preferred (a combination of experience and education will be considered in lieu of a degree). One to three years in healthcare financial analytics or hospital / professional billing experience is preferred. Experience with commercial and governmental payers is preferred. Must possess strong Microsoft Excel and analytical skills. Certified Professional Coder certification is required (can be obtained within six (6) months after hire).

Additional Skills :

Knowledge of CPT-4, HCPCS, UB-04, HCFA 1500 and ICD-10 Coding as well as OPPS & CCI edits.

Ability to work independently, exercising sound judgement, discretion and initiative.

Leads meetings and workgroups. Influences and contributes to strong sense of teamwork and collaboration.

Knowledgeable in EPIC and other patient financial / accounting systems.

Proficient in using personal computers and Microsoft Office products.

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