Billing & Compliance Analyst - Rochester General Hospital (Full-Time, Days)
About The Position
The Billing & Compliance Analyst assists with strategies to improve laboratory charge capture, coding, billing, and compliance. The position helps ensure accurate and timely billing information for reimbursement for services rendered and uses system resources to resolve issues and prepare reports. The analyst coordinates billing audits, special projects, and proactive studies to assess billing quality; reviews billing codes; develops reports and analyzes accounts receivable and revenue-cycle metrics; and recommends process improvements. The role works with laboratory departments, coding and charge-capture teams, CBO, HIM, business office staff, and the CareConnect IT team to investigate billing, coding, system, payer, and interface issues. It also supports software implementations and updates through testing and validation, maintains laboratory billing files and the chargemaster, and coordinates training and policy updates as needed. This is a full-time, onsite role at Rochester General Hospital, scheduled Monday through Friday for 8-hour shifts from 8:00 a.m. to 4:30 p.m. The position is sedentary and primarily office-based.
Requirements
- Previous billing and third-party payer experience.
- At least 4 years of related work experience in billing and/or patient access, working with CPT codes.
- Ability to effectively and efficiently use system resources to resolve issues and prepare reports.
- Associate's degree is preferred.
- Experience with Epic, SoftAR/SCC, LIS applications, healthcare billing, coding, revenue cycle, or chargemaster management is preferred.
- Knowledge of CPT, HCPCS, Medicare, Medicaid, and commercial payer billing requirements is preferred.
- Strong analytical and problem-solving skills are preferred.
- Experience working across departments such as laboratory operations, finance, IT, and revenue cycle is preferred.
- Advanced Excel and data-analysis skills are preferred.
- Ability to independently manage multiple priorities and investigate complex billing, charging, and interface issues is preferred.
Nice To Haves
- Associate's degree.
- Experience with Epic, SoftAR/SCC, LIS applications, healthcare billing, coding, revenue cycle, or chargemaster management.
- Knowledge of CPT, HCPCS, Medicare, Medicaid, and commercial payer billing requirements.
- Strong analytical and problem-solving skills.
- Experience working across laboratory operations, finance, IT, and revenue cycle.
- Advanced Excel and data-analysis skills.
- Ability to manage multiple priorities independently and investigate complex billing, charging, and interface issues.
Responsibilities
- Collaborate with healthcare professionals to discuss findings and provide advice and education aimed at improving denial rates.
- Work with CBO and HIM to identify billing adjustments and denial issues.
- Conduct annual billing code reviews and coordinate with coding and charge-capture teams.
- Develop billing reports to identify charging or coding issues and report findings to the office manager.
- Create pivot tables and perform data mining.
- Participate in appropriate committees.
- Coordinate and conduct billing audits and special projects, including research into billing, system, and third-party payer issues affecting compliance and reimbursement.
- Plan and complete proactive studies to assess billing quality.
- Discuss billing compliance issues with laboratory departments and recommend procedural or process changes as directed by the manager.
- Develop and update department policies as needed.
- Keep current with CMS national and local coverage policies and other CMS regulations.
- Coordinate training for lab registrars on billing and registration processes that affect reimbursement, as requested.
- Review and analyze processes, recommend improvements, define implementation time frames, and lead related process-improvement teams.
- Assist coding staff with NCCI and MUE issues.
- Author help-star tickets to correct system errors identified by observing trends in work queues.
- Work with the CareConnect IT team to resolve claims and software issues, including testing billing application changes and updates.
- Facilitate professional and technical revenue-billing-cycle functions to support cash-flow goals.
- Ensure systems operate in accordance with departmental and regulatory compliance requirements.
- Identify recurring issues and trends affecting HB and PB billing management productivity, training, and education.
- Review open billing invoices; provide feedback to business office supervisors on work quality and productivity; provide individual and group training; and document corrective actions when needed.
- Monitor revenue-cycle and accounts-receivable progress and potential problems, and assist in developing and implementing solutions.
- Prepare status reports and presentations for the RGHS Executive Leadership Team and Finance Committee, and report key accounts-receivable metrics weekly and monthly.
- Represent the business office in software implementations and process changes or updates, participating in testing to protect the financial integrity of the revenue cycle.
- Use SoftLab LIS functions related to accounts receivable, including running billing files and setting up new tests and insurances; work with the LIS team on upgrades and implement, test, and validate billing flow for each test.
- Use databases and required database hot fixes and validations, and ensure billing files work correctly.
- Maintain the Laboratory Chargemaster and ensure CareConnect billing requirements are met for each test added to the system.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
