Revenue Cycle Analyst, PB

Hackensack Meridian Health•Hasbrouck Heights, NJ

5d•Onsite

About The Position

The Revenue Cycle Analyst, PB provides statistical and financial data enabling management to accurately monitor accounts receivable activity on an ongoing basis. Identifies issues for management regarding significant changes in various accounts receivable categories reflected in the daily dashboards and denial reports. Supports the Revenue Cycle team and Practice Management by monitoring key metrics related to revenue and accelerated cash flow. This position performs high level analysis of accounts receivable and uses considerable judgment to determine solutions to complex problems. All tasks must be performed in a timely and accurate manner. Meets with appropriate Revenue Cycle leaders and makes recommendations to prevent future denials and payment variances. Disciplines include but are not limited to Patient Accounting, Case Management, Health Information, Clinical, Training, Managed Care, Outsource Partners, Practice Management and IT . Duties performed are at multiple sites within the Hackensack Meridian Health (HMH) Network.

Requirements

Bachelor's degree or equivalent HMHN work experience.
Minimum of 4 years of related work experience.
Strong analytical, mathematical, and report writing skills.
Knowledge of computers or hospital billing systems.
Thorough knowledge of billing requirements and regulations of major payers.
Excellent written and verbal communication skills.
Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.
Certification or Proficiency in Epic HB Fundamentals within 6 months of hire.
Certification or Proficiency in Epic HB Insurance Follow-Up within 3 months of hire.
Must successfully pass completion of EPIC assessment within 30 days after Network access granted.

Nice To Haves

Bachelor's degree.
Experience in healthcare.
Knowledge of Managed Care contracts, Medicare, and Medicaid.
Proficient in SMS, Epic and/or other hospital billing systems.
Knowledge of ICD-9/10 and medical terminology.

Responsibilities

Participates & Reports on Weekly Graph & Workflow meetings on Denials trending for the Network. Identifies and performs root cause analysis of high-volume denials and underpayments, and presents the findings to the Revenue Cycle team. Communicates improvement opportunities and corrective actions based on findings.
Act as Team Leader to ensure all team members are trained & aligned with established Desktop & policies & procedures.
Performs analytical review of denials to support Revenue Operations, Case Management, Access, and other departments as it relates to denials and payment variances. Determines the reasons for denials, meets with appropriate Revenue Cycle leaders and Practice Management, and makes recommendations to prevent future denials and payment variances.
Identifies problems in process flow or changes in payer's billing rules and regulations and governmental guidelines that slows cash flow and workflow and disseminates information to management.
Collaborates with the Training department on developing education materials based from the resolutions/outcomes of the improvement opportunities presented at inter disciplinary meetings.
Collaborates with Department Manager in developing processes and workflows on trends identified on various areas of operation.
Process Patient and Insurance refund and other overpayment request.
Prepares trending reports of all high volume denials and payment variances. Meets biweekly and monthly with various departments to communicate findings and recommendations to improve revenue management.
Works closely with front-end (Access) regarding up-front cash collection, registration, and eligibility denials. Schedules biweekly meetings to resolve issues that will slow cash collection. Respond to Practice Management inquiries.
SME (Subject Matter Expert) for complex denials and payment variances including contracts, fee schedules, and edits. Educates and provides feedback to various areas on Revenue Cycle metrics and key performance indicators.
Utilizes and develops new Epic and ad-hoc accounts receivable or denial reporting tools for management, using the current information system and/or other software programs to achieve desired reporting outcomes.
Tracks and reports on causes of manual adjustments which will be the basis of escalation to Information Technology for contract management corrections.
Performs staff audits based on manual adjustment reports. Reviews activities to improve the revenue cycle. Ensures that the team is following departmental procedures and are in compliance with governmental and commercial payer guidelines.
Performs reimbursement management, analyzes payer reimbursement to ensure proper claim adjudication, and tracks and reports on high volume payment discrepancies which will be used as escalation to Managed Care, the payer, or IT. Monitors payments denials and initiates CPT or DRG analysis to determine reasons for denial.
Monitors daily dashboard and reports and conducts analytical reviews to determine if changes or enhancements on current policies and procedures are required.
Participates, schedules, and coordinates meetings respond to inquiries with appropriate personnel to exchange ideas on working towards accounts receivable related changes or enhancement and works closely with the Department Manager to develop required reports for the meeting.
Conducts accounts receivable audits as defined by SVP, Sr Revenue Officer and Revenue Operations Managers. Analyzes manual adjustment reports monthly to evaluate appropriateness, and report findings to the SVP, Sr Revenue Officer.
Monitor variance report to determine if rate in Contract Management was loaded correctly or the variance is due to underpayment. Report Contract variance to IT, escalate volume underpayments to payer representative.
Meets biweekly and monthly with various vendors and outside agencies to discuss bottlenecks in revenue flow and discusses solutions. Acts as a liaison between agencies, practice management and Reconciliation department to prevent AR aging and timely flow of communication.
Monitors account work queues, analyzes trends, and follows up if metrics exceed or fall below baselines.
Assists with ongoing management of Epic as it relates to Resolute Hospital Billing Nova Notes and other Epic enhancements.
Able to perform all Adjustment Representative functions/tasks and other duties as assigned.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.