PFS Analyst

Catholic Health•Melville, NY

4d•$60,000 - $100,000

About The Position

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Job Details Under the direction of the Manager and Director of PFS, the Analyst is responsible to develop metrics to track overall performance and operations for the department against established benchmarks. Additionally, the Analyst will conduct through analysis and provide the Vice President of Revenue Cycle and PFS System Director with recommendations for optimization, performance improvement and achieving financial goals. POSITION REQUIREMENTS AND QUALIFICATIONS: Contributes to and consistently applies CH Services’ policies, procedures, and benefits to all customers and/or employees without discrimination. Employee conducts himself/herself in conformity with the HIPAA Compliance Program and applicable institutional policies and procedures for patient privacy. In addition, employee conducts himself/herself in conformity with the CHS Security policies and procedures. Builds system and hospital-specific A/R portfolios by payer, operational division and external vendors in multiple reporting PFS systems. Creates payment, adjustment and write offs analysis for specific payers, operational divisions and the system as a whole. Leads monthly analysis of account receivables by hospital and carrier plan including debits and credits. Summarizes and communicates trends in reimbursement, contract variances payment delays and staffing to leadership. Validates fee schedules against contracts; performs revenue modeling for specific payers and outlines risks and gains to contract terms. Works with Directors on recovery efforts tied to identified variances and denials by insurance carrier for managed care negotiations. Prepares external expense tracking, performance assessment and analysis. Proposes cost savings measures and efficiencies based on vendor performance. Collects data and prepares analysis of proposed payer-based settlements against open debits and credits. Conducts payment analysis in conjunction with Finance department to assess collection performance year over year. Conducts analysis of revenue impact associated with changes in payment models or other initiatives. Prepares monthly analysis of hospital revenue cycle performance. Works with Revenue Cycle and Managed Care team to identify and resolve issues related to timely payment. Updates issue lists and reports. Adheres to all organizational policies and procedures.

Requirements

Bachelor’s degree required. Master degree preferred.
Proficient in designing, building reports and analyses in various Microsoft based data analysis tools. Proven experience working with large and complex SQL databases preferred.
Ability to analyze and accurately summarize complex claims data and effectively communicate conclusions
At least three years’ experience with analysis preferable in a healthcare or managed care setting.
Strong knowledge of the managed care environment including provider, payer, and employer.

Nice To Haves

Experience with hospital billing and or decision support systems a plus.

Responsibilities

Develop metrics to track overall performance and operations for the department against established benchmarks.
Conduct through analysis and provide the Vice President of Revenue Cycle and PFS System Director with recommendations for optimization, performance improvement and achieving financial goals.
Contributes to and consistently applies CH Services’ policies, procedures, and benefits to all customers and/or employees without discrimination.
Employee conducts himself/herself in conformity with the HIPAA Compliance Program and applicable institutional policies and procedures for patient privacy. In addition, employee conducts himself/herself in conformity with the CHS Security policies and procedures.
Builds system and hospital-specific A/R portfolios by payer, operational division and external vendors in multiple reporting PFS systems.
Creates payment, adjustment and write offs analysis for specific payers, operational divisions and the system as a whole.
Leads monthly analysis of account receivables by hospital and carrier plan including debits and credits. Summarizes and communicates trends in reimbursement, contract variances payment delays and staffing to leadership.
Validates fee schedules against contracts; performs revenue modeling for specific payers and outlines risks and gains to contract terms.
Works with Directors on recovery efforts tied to identified variances and denials by insurance carrier for managed care negotiations.
Prepares external expense tracking, performance assessment and analysis. Proposes cost savings measures and efficiencies based on vendor performance.
Collects data and prepares analysis of proposed payer-based settlements against open debits and credits.
Conducts payment analysis in conjunction with Finance department to assess collection performance year over year.
Conducts analysis of revenue impact associated with changes in payment models or other initiatives.
Prepares monthly analysis of hospital revenue cycle performance.
Works with Revenue Cycle and Managed Care team to identify and resolve issues related to timely payment.
Updates issue lists and reports.
Adheres to all organizational policies and procedures.