Revenue Cycle Process Improvement Systems Analyst

The Ohio State University

2d • Onsite

About The Position

The Revenue Cycle Process Improvement Systems Analyst serves as an internal consultant supporting and driving implementation of the revenue cycle improvement initiative using a structured industry approved approach. This position is supportive of all revenue cycle process improvement strategic initiatives. The Revenue Cycle Process Improvement Systems Analyst is also responsible for a wide variety of functions that primarily revolve around analyzing and resolving issues with accounts that involve authorization, billing, and compliance. This position serves as an expert in understanding the payers’ requirements and works with various other departments to identify issues and resolve them prior to billing or after a denial is received. This position is responsible for providing a higher-level review of all medical necessity and authorization denials to determine a root cause for the denials. This position analyzes data to identify historic trends, perform comparisons against identified standards, and assists in formulating strategic plans for appealing denials. This position uses expert knowledge of payer authorization requirements to write and submit appeals for administrative authorization denials. Identifies and develops appropriate tools to track issues, analyzes workflows, identifies logistical and operational issues to target for improvement. Further, this position is responsible for reviewing accounts with various claim errors that require a second higher-level/comprehensive review. This can include claims with admission or discharge date discrepancies, admission order timing issues, or various other regulatory compliance issues. This position is also responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle and serve as the primary trainer for onboarding peers with less experience. This position must apply industry knowledge and a thorough understanding of all available systems where revenue cycle information is held, including Midas and EPIC modules for Cadence, ADT, Ambulatory, and Resolute.

Requirements

• Bachelor's degree or equivalent experience.
• 4 years of relevant experience required.

Nice To Haves

• Advanced degree in relevant field may be desirable.
• 4-8 years of relevant experience preferred.

Responsibilities

• Serves as an internal consultant supporting and driving implementation of the revenue cycle improvement initiative.
• Analyzes and resolves issues with accounts involving authorization, billing, and compliance.
• Serves as an expert in understanding payers’ requirements and works with various departments to identify and resolve issues.
• Provides a higher-level review of medical necessity and authorization denials to determine root causes.
• Analyzes data to identify historic trends, perform comparisons against identified standards, and assists in formulating strategic plans for appealing denials.
• Writes and submits appeals for administrative authorization denials using expert knowledge of payer authorization requirements.
• Identifies and develops appropriate tools to track issues, analyzes workflows, and identifies logistical and operational issues for improvement.
• Reviews accounts with various claim errors requiring a second higher-level/comprehensive review (e.g., admission/discharge date discrepancies, admission order timing issues, regulatory compliance issues).
• Responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle.
• Serves as the primary trainer for onboarding peers with less experience.
• Applies industry knowledge and a thorough understanding of all available systems where revenue cycle information is held, including Midas and EPIC modules for Cadence, ADT, Ambulatory, and Resolute.

Benefits

• Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
• Paid time off, including sick and vacation time and 11 holidays.
• State retirement plan or an alternative retirement plan, both with generous employer contributions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree