Billing & Compliance Analyst - Rochester General Hospital (Full-Time, Days)

Rochester Regional Health • Rochester, NY

4d • Onsite

About The Position

The Billing & Compliance Analyst assists with strategies to improve laboratory charge capture, coding, billing, and compliance, helping ensure that services rendered are billed accurately and on time for reimbursement. The role uses system resources to resolve issues and prepare reports, monitors billing quality and revenue-cycle performance, and recommends process improvements.

The analyst works with laboratory departments, healthcare professionals, the Central Billing Office (CBO), Health Information Management (HIM), coding and charge-capture teams, business office staff, finance, and IT. Responsibilities include billing audits, coding reviews, denial and accounts-receivable analysis, training, policy updates, and support for billing software changes and implementations. The role also maintains laboratory billing workflows and the chargemaster, including validating billing flows and ensuring billing files operate correctly.

This is a full-time, 40-hour-per-week position at Rochester General Hospital in Rochester, New York. The schedule is Monday through Friday, with 8-hour shifts from 8:00 a.m. to 4:30 p.m. The role is described as sedentary and primarily office-based.

Requirements

• Previous billing and third-party payor experience.
• At least 4 years of related work experience in billing and/or patient access, working with CPT codes.
• Strong analytical and problem-solving skills.
• Ability to work across multiple departments, including 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.

Nice To Haves

• Associate's degree.
• Experience with Epic, SoftAR/SCC, or laboratory information system applications.
• Experience in healthcare billing, coding, revenue cycle, or chargemaster management.
• Knowledge of CPT, HCPCS, Medicare, Medicaid, and commercial payer billing requirements.

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 interface 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, or 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 changes to procedures or processes 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, make recommendations, and define implementation time frames for improvements.
• Lead related process-improvement teams.
• Assist coding staff with NCCI and MUE issues.
• Author help star tickets to correct system errors identified through trends in various work queues.
• Work with the CareConnect IT team to resolve claims and software concerns, including testing billing application changes and updates.
• Facilitate professional and technical revenue-cycle billing functions to support cash flow within established goals.
• Ensure systems operate in accordance with departmental and regulatory compliance requirements.
• Identify trends and recurring issues affecting HB and PB billing management teams' productivity, training, and education.
• Routinely review open billing invoices; provide quality and productivity feedback to business office supervisors; provide individual or group training as needed; and document corrective actions when needed.
• Monitor revenue-cycle and accounts-receivable progress and potential problems, and assist with developing and implementing solutions.
• Prepare status reports and presentations for the RGHS Executive Leadership Team and Finance Committee.
• Develop and report key accounts-receivable metrics weekly and monthly.
• Represent the business office during software implementations or process changes and updates; participate in billing application testing to protect revenue-cycle financial integrity.
• Use the SoftLab Laboratory Information System for accounts-receivable functions, including running billing files and setting up new tests and insurances.
• Work with the Laboratory Information System team on system upgrades.
• Implement, test, and validate billing flow for each test; maintain database proficiency and required 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed