Payment Integrity Analyst

UCSF•Emeryville, CA

About The Position

Under general supervision, applies acquired skills as a revenue cycle analyst to complete projects of moderate scope and complexity. Thought leader with working knowledge in the overall field and developing expertise in specific areas; problem-solving frequently requires analysis of unique issues/problems without precedent and/or structure. Provides high-level support to team members and programs that include formulating strategies and administering policies, processes, and resources, and functions with a high degree of autonomy. The Payment Integrity Analyst contributes to initiatives to effectively model, demonstrate, and guide others with their working knowledge, root cause analysis, summary of findings, and communications to facilitate awareness, discussions, problem-solving, and decision-making to ensure payment integrity and optimization. The Payment Integrity Analyst plays an integral role is supporting various stakeholders through payment integrity and revenue optimization projects with operational leaders across the revenue cycle community. Successful team partnerships include, and are not limited to, revenue cycle analysts and leadership teams spanning UCOP, UCSF Health Revenue Cycle, HPS, OMAG, Clinical Departments, Insurance Payers, and EBOs, etc. The incumbent will coordinate with department leaders to understand and prioritize data and information requirements aimed at maximizing revenue on behalf of the UCSF Health System and UCOP. The Payment Integrity Analyst will collaborate with fellow analysts to conduct root cause analytics, provide project management support, contribute to strategic decision-making sessions, and utilize effective spoken and written communications wherever applicable, and aid in the development, dissemination, and implementation of training materials that support operational initiatives. The Payment Integrity Analyst applies knowledge and understanding to summarize, research, communicate, and disseminate relevant information pertaining to operational workflow efficiencies, revenue performance dashboard proficiency, insurance payment integrity, and overall revenue optimization. Expected to apply innovative methods to access, analyze, interpret, and provide information about payment integrity initiatives. Initiatives can include, and are not limited to, underpaid claims, fee schedule reconciliations, payment delay, payer contract negotiations, escalated payer issues by revenue cycle stakeholders, etc. Further, this position assists with payment analysis for a variety of short- and long-term performance improvement projects using all available analytical tools. Where necessary, the incumbent, along with their colleagues, will educate and train relevant parties on payer policies and documentations to enhance claim edits that will reduce administrative burden, increase charge timeliness and clean claim submissions, mitigate denials and avoidable write-offs, and drive increased payments in a timelier fashion. The incumbent will gather and assess any additional key performance indicators and partner with EIA to enhance and/or develop additional business intelligence analytical tools, such as a Payer Performance Report Card. The incumbent will work with their leadership team to support revenue cycle functions for the healthcare enterprise, including system billing review, insurance payment validation, accuracy, and integrity, revenue optimization project management, and data-driven analytics to facilitate strategic decision-making and inform standard workflow development and implementation. Aids in ensuring fee schedule accuracy and maintenance, insurance reimbursement per current contract rates, and leverages predictive analytics and proactive communications to support and drive optimal reimbursement for services. Collaborates with and informs all pertinent stakeholders to monitor and improve insurance payer performance, including payer behavior tracking, provider relations escalations, and analytic tools training and education. Insurance payment and fee schedule reconciliation, payment reimbursement integrity and project management, payer contracts management and integration, and representation amongst all forums related to UCSF Health System’s revenue cycle. Works with leaders to ensure billing and payment information contains accurate and comprehensive data to ensure payment accuracy. Impacts processes to include timely billing, payment posting, refund processing, AR management, and optimal collections. Indirectly responsible for / integrated with all business office operations impacting payment integrity. Currently, this position will report to the Assistant Director of Revenue Management and Payment Integrity.

Requirements

Working knowledge in the overall field and developing expertise in specific areas.
Problem-solving frequently requires analysis of unique issues/problems without precedent and/or structure.
Functions with a high degree of autonomy.
Ability to coordinate with department leaders to understand and prioritize data and information requirements.
Ability to collaborate with fellow analysts to conduct root cause analytics, provide project management support, and contribute to strategic decision-making sessions.
Utilize effective spoken and written communications wherever applicable.
Ability to apply knowledge and understanding to summarize, research, communicate, and disseminate relevant information pertaining to operational workflow efficiencies, revenue performance dashboard proficiency, insurance payment integrity, and overall revenue optimization.
Ability to apply innovative methods to access, analyze, interpret, and provide information about payment integrity initiatives.
Ability to assist with payment analysis for a variety of short- and long-term performance improvement projects using all available analytical tools.
Ability to educate and train relevant parties on payer policies and documentations.
Ability to gather and assess any additional key performance indicators.
Ability to support revenue cycle functions for the healthcare enterprise, including system billing review, insurance payment validation, accuracy, and integrity, revenue optimization project management, and data-driven analytics to facilitate strategic decision-making and inform standard workflow development and implementation.
Ability to aid in ensuring fee schedule accuracy and maintenance, insurance reimbursement per current contract rates, and leverages predictive analytics and proactive communications to support and drive optimal reimbursement for services.
Ability to collaborate with and inform all pertinent stakeholders to monitor and improve insurance payer performance, including payer behavior tracking, provider relations escalations, and analytic tools training and education.
Ability to ensure billing and payment information contains accurate and comprehensive data to ensure payment accuracy.
Experience with insurance payment and fee schedule reconciliation, payment reimbursement integrity and project management, payer contracts management and integration.

Nice To Haves

Thought leader with working knowledge in the overall field and developing expertise in specific areas.

Responsibilities

Contribute to initiatives to effectively model, demonstrate, and guide others with their working knowledge, root cause analysis, summary of findings, and communications to facilitate awareness, discussions, problem-solving, and decision-making to ensure payment integrity and optimization.
Support various stakeholders through payment integrity and revenue optimization projects with operational leaders across the revenue cycle community.
Coordinate with department leaders to understand and prioritize data and information requirements aimed at maximizing revenue on behalf of the UCSF Health System and UCOP.
Collaborate with fellow analysts to conduct root cause analytics, provide project management support, contribute to strategic decision-making sessions, and utilize effective spoken and written communications wherever applicable.
Aid in the development, dissemination, and implementation of training materials that support operational initiatives.
Apply knowledge and understanding to summarize, research, communicate, and disseminate relevant information pertaining to operational workflow efficiencies, revenue performance dashboard proficiency, insurance payment integrity, and overall revenue optimization.
Apply innovative methods to access, analyze, interpret, and provide information about payment integrity initiatives.
Assist with payment analysis for a variety of short- and long-term performance improvement projects using all available analytical tools.
Educate and train relevant parties on payer policies and documentations to enhance claim edits that will reduce administrative burden, increase charge timeliness and clean claim submissions, mitigate denials and avoidable write-offs, and drive increased payments in a timelier fashion.
Gather and assess any additional key performance indicators and partner with EIA to enhance and/or develop additional business intelligence analytical tools, such as a Payer Performance Report Card.
Support revenue cycle functions for the healthcare enterprise, including system billing review, insurance payment validation, accuracy, and integrity, revenue optimization project management, and data-driven analytics to facilitate strategic decision-making and inform standard workflow development and implementation.
Aid in ensuring fee schedule accuracy and maintenance, insurance reimbursement per current contract rates, and leverages predictive analytics and proactive communications to support and drive optimal reimbursement for services.
Collaborate with and inform all pertinent stakeholders to monitor and improve insurance payer performance, including payer behavior tracking, provider relations escalations, and analytic tools training and education.
Ensure billing and payment information contains accurate and comprehensive data to ensure payment accuracy.
Impact processes to include timely billing, payment posting, refund processing, AR management, and optimal collections.