Senior RCM Project Analyst

Aegis Sciences•Nashville, TN

37d

About The Position

The Senior RCM (Revenue Cycle Management) Project Analyst is responsible for analyzing and optimizing the financial processes within a laboratory organization, including patient registration, coding, billing, and collections, by reviewing data to identify trends, areas for improvement, and implementing strategies to maximize revenue while ensuring compliance with regulations, ultimately improving the overall revenue operations experience.

Requirements

High school diploma or GED required; Degree in Business, Finance or related discipline preferred
With a high school diploma, a minimum of eight (8) years of experience in denials management and other areas of Healthcare Revenue Cycle Functions required; with a Bachelor's degree, a minimum of six (6) years of experience in denials management and other areas of Healthcare Revenue Cycle Functions required; with a Master's degree, a minimum of four (4) years of experience in years of experience in denials management and other areas of Healthcare Revenue Cycle Functions required
Experience using reporting tools and advanced excel skills required
Knowledge of insurance including Medicare, Medicaid, Blue Cross Blue Shield and Third-Party Payers required
Ability to utilize critical thinking skills while performing reimbursement/denial analysis

Responsibilities

Work closely with Revenue Cycle Leadership, Revenue Cycle Business Analysts, and Revenue Cycle Financial Analysts to support the full RCM lifecycle including the following:
Conduct root cause analysis and investigate recurring issues on claim denials, delayed or incorrect payments, and propose corrective actions
Analyze and improve revenue cycle processes through workflow evaluation and efficiency improvement recommendations
Support strategic initiatives through collaboration and alignment of organizational goals, cost reduction, and revenue enhancement
Lead strategic, long-term projects and support solution development
Ensure adherence to healthcare regulations and coding guidelines, including HIPAA and ICD-10 coding standards
Develop and implement strategies to address identified issues, including workflow changes, training programs, and system updates to enhance revenue cycle efficiency
Provide other Revenue Cycle Analysts and Specialists one-on-one training/cross training for reviewing and interpreting medical records and internal documentation to enhance appeal strategies
Make informed decisions based on knowledge of Payer policy and knowledge, state and federal guidelines and thorough review of internal documents including the translation of testing protocols and billing and how that impacts the adjudication of a claim to achieve a positive outcome
Collaborate with payers, managed care, clinical and legal to resolve outstanding claims and address billing issues
Analyze large volumes of revenue cycle data, including patient demographics, insurance verification, claim submissions, denial trends, and payment history to identify patterns and areas for improvement
Develop and maintain key performance indicators (KPIs) like days sales outstanding (DSO), denial rates, clean claim submission rates, and collection efficiency to track revenue cycle performance
Analyze and synthesize complex information to identify key issues, develop clear summaries, and define actionable next steps; collaborate across teams to ensure alignment, drive resolution, and maintain momentum on strategic initiatives