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Revenue Cycle Integrations and Banking Analyst

3 months ago

Temecula, California, United States Rancho Health MSO Full time

Job Summary:


The intent of this job description is to provide a summary of the major duties and responsibilities performed in this job.

Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.


The Revenue Cycle Integrations & Banking Reconciliation Analyst is responsible for creating procedures to onboard new practices (M&A) which includes but is not limited to Front office collections, office deposits, check handling, billing vendor management, provider contracts, managed care arrangements.

Oversights performance of Billing vendors. The Analyst will coordinate between all departments such as credentialing, operations, providers pre- and post-acquisition. Works with existing practices on standardizing policies and procedures for revenue collections, reconciliation, system build, enhancements. Communicates with RCM Sr. Manager and Operations management on any UCSD system or contract issues.

The Analyst ensures that the practice management system is recording transactions accurately, provider documentation meets requirements for billing and sets quality and compliance as top priorities.

Conducts audits on all aspects of revenue cycle. The manager keeps updated on changes in the industry which affect integrated aspects of clinical operations and revenue cycle. Designs training programs and delivers across affiliates. Understands industry KPI's in Accounts receivables management and accounting principles for appropriate book to bank audit trail. Works with leader on strategic initiatives to enhance efficiency and automation across groups.

Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Works with the AP department to create workflows and policies for reconciliation, RCM vendor management, front office deposit procedures etc.

for each affiliated group. Pre & post-acquisition
Develops Payment reconciliation workflows in the various systems and builds bank match reports.
Develops procedure for Operations managers to deposit and balance in-office and mailed-in collections.
Ensures accounting integrity for all revenue streams related to patient receivables.
Conducts meetings with Revenue Cycle and operation partners for prospect and acquired groups.
Delivers accounts receivable reports, trending procedure codes, denials and payment patterns.
Reviews monthly revenue reports for acquired groups and escalates areas needing attention.
Manages special projects across groups to improve collections efficiency.
Creates a collaborative funnel of communication with Operations/Finance/RCM leaders and providers.
Reviews fee schedules, contracts for M& A's and ensures leadership is aware of requirements or actions.
Provides support to Credentialing for conversion of TIN with payors, programming in the PMS systems, clearinghouse enrollments. Provides analysis of PMS capabilities to accommodate multiple TIN's.
Understands the Practice Management systems and can make/recommend basic programming changes.
Understands reporting system and can deliver open AR analysis to predict revenue fluctuations.
Oversees revenue partners deliverables and organizes monthly financial review structure.
Ensure Billing compliance and shares with management any areas of risk to effect corrective action.

Keep all docs relevant to RCM functions and contracting up to date in the data repository e.g., fee schedule, w9 forms, contracts etc.


Required education and experience:
The requirements listed below are representative of the knowledge, skills, and/or ability required.

Minimum Education required:
Bachelor's degree.
Billing or coding certifications or equivalent years of healthcare accounting experience.

Minimum Experience Required:
Knowledge of banking and revenue cycle processes.
Versed in CMS guidelines and other regulatory guidelines for Billing Compliance.
Knowledge of insurances i.e. HMO, PPO, Medicare, IPA's.
Minimum five years' experience in medical billing and/or medical office at a project/systems analyst level.

Minimum Knowledge and Skills Required:
Duties require professional verbal and written communication skills.
Understanding of principles and practices of the organization, planning, records management, and general administration.
Dependability, adaptability, and confidentiality are necessary attributes.
Ability to work with operations, clinical staff, and handle direction from multiple sources.
Commitment to the concepts of preventative health care and team approach to health care delivery.

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