Revenue Cycle Quality & Performance Management Analyst

Northwell Health

2d•Remote

About The Position

Analyzes, identifies and recommends and delivers plans and training materials throughout implementation and helps ensure smooth operations post-implementation. Serves as an operations consultant for Revenue Cycle Business Operations implementation and maintenance. Liaises between various project teams. Investigates root causes of charge integrity issues at the CPT code, provider, and service line level, and partners with Clinical Operations, IT, and Revenue Cycle stakeholders to design and implement sustainable corrections. Monitors and analyzes Epic Resolute Professional Billing charge capture and routing workflows, including Revenue Guardian and Charge Router reconciliation reports, to proactively identify charge fallout, encounter errors, and edit trends that impact clean claim submission and reimbursement. Engages in charge stabilization efforts during and post-Epic go-live periods, including preparedness meetings with service line contacts, backlog resolution, and targeted retraining to ensure charging workflows are functioning as intended and reconciliation compliance is maintained across all locations and service lines.

Requirements

Bachelor's Degree required, or equivalent combination of education and related experience.
1-3 years of relevant experience, required.

Nice To Haves

Advanced Microsoft Excel skills
Strong comprehension of Epic Resolute Professional Billing and/or Epic Charge Router
Prior experience working charge edits within Epic Charge Review work queues
Familiarity with Hospital Outpatient Department (HOPD) / NYS Article 28 billing requirements from a Professional Billing perspective
Experience with Epic Revenue Guardian reporting and reconciliation workflows
Background in revenue integrity, charge capture auditing, or healthcare compliance

Responsibilities

Analyzes, implements, and maintains revenue cycle activities across sites and ensures goal setting and tracking.
Makes recommendations for development and analysis of implementation plans for System development and implementation of Revenue Cycle Business Operations which may include discovery, design, conversion, testing, and/or any other components of the project plan cycle.
Serves as a liaison between business and technology teams.
Participates in developing and delivering training programs for current and prospective users.
Educates practice, site and corporate management on Revenue Cycle Business Operations policies and procedures.
Assists implementation team in configuring HIPAA rules based on System policies and legal requirements.
Ensures processes are compliant with system policies, applicable laws and contractual bargaining agreements.
Develops procedures for system audits.
Resolves discrepancies, as required.
Collaborates with implementation teams to resolve user issues.
Consults with departments to provide customer support during and post- implementation.
Troubleshoots issues and resolves concerns as well as recommends necessary fixes.
Advises management of results and recommends actions.
Consults with newly acquired facilities and designs transition and implementation plans.
Performs related duties as required.
Investigates root causes of charge integrity issues at the CPT code, provider, and service line level, and partners with Clinical Operations, IT, and Revenue Cycle stakeholders to design and implement sustainable corrections.
Monitors and analyzes Epic Resolute Professional Billing charge capture and routing workflows, including Revenue Guardian and Charge Router reconciliation reports, to proactively identify charge fallout, encounter errors, and edit trends that impact clean claim submission and reimbursement.
Engages in charge stabilization efforts during and post-Epic go-live periods, including preparedness meetings with service line contacts, backlog resolution, and targeted retraining to ensure charging workflows are functioning as intended and reconciliation compliance is maintained across all locations and service lines.