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CHS Revenue Cycle Quality Analyst

4 months ago

Ithaca, United States Cayuga Medical Center Full time
Job DescriptionJob Description

Company Overview:

Cayuga Health is the region's leading healthcare system, and most trusted driver of integrated health services, together with valued partners. We empower our people and employ our capabilities to equitably improve the well-being of the communities we serve. At Cayuga Health System, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies, and research protocols. We have a commitment to its employees by providing competitive rates and compensation, a comprehensive employee benefits programs, attractive working conditions, and the chance to build and explore a career opportunity by offering professional development.

Nestled in the beautiful Finger Lakes region, Cayuga Health provides an outstanding place to work in a vibrant community. Come discover all that Ithaca, New York and Cayuga Health has to offer

The CHS Revenue Cycle Quality Analyst works as an integral part of the Revenue Cycle team. The Quality Analyst performs quality assurance reviews of the Revenue Cycle workflows, assuring quality, accuracy, timeliness and appropriateness standards are maintained and quality standards are measured and achieved. Serves as subject matter expert with regard to revenue cycle systems and workflows used in the business unit needed to ensure appropriate use and maximum efficiency. In addition, performs process, operational and system workflow monitoring/reviews to ensure that efficient, cost-effective work processes are being executed. This position collaborates with all departments to ensure development of revenue cycle quality metrics and quality review process. This individual will foster and drive a culture of patient centered care, quality outcomes, and service excellence in a fast growing environment through the planning, development, and implementation of key quality programs and initiatives.

Position Overview:

  • Compiles productivity data for employees subject to QA review process, and prepares regularly scheduled management reports. Identifies opportunities for improvement, and establishes recommendations for the management team.
  • Validates productivity measurements, and provides continuous monitoring of the efficacy of the production standards. Conducts regularly scheduled reviews of accounts worked, and all related activities associated with resolution of claims.
  • Performs regularly scheduled reviews of business unit processes to identify errors and areas where education/system enhancements are needed.
  • Responsible for auditing third party partners and vendors if necessary.
  • Completes QA analysis of all critical claims processing, follow up and denial elements using QA audit tools to correctly identify users. Review and respond to all quality audit inquiries which include disputed findings and implement quality assurance initiatives.
  • Performs routine system and process testing as requested by the Revenue Cycle or other operational areas.
  • Prepares monthly QA evaluation reports and submits detail and summary reporting to appropriate leadership.
  • Identifies, recommends, documents and tracks resolution to process gaps and best practice to Strategy and Operations teams for ongoing process improvements needed in the department. Participates in local and enterprise-wide initiatives to promote data quality and quality improvement.
  • Computes and reports statistical QA data in a variety of formats, without computational errors, spotting trends and/or patterns.
  • Maintains in-depth knowledge of insurance follow up and denials systems, department policies, procedures and workflows.
  • Other duties as assigned.

Minimum Qualifications:

Education:

  • Associate's degree with 3 years of revenue cycle experience required.
  • In lieu of an Associate's degree, high school diploma with 5 years of revenue cycle experience required.
  • 3 years of quality/audit experience (preferred)

Experience:

  • Minimum 3 years hospital revenue cycle experience
  • Knowledge of the managed care industry including payer structures, administrative rules, and government payers.
  • Knowledge of revenue cycle including, patient access, insurance billing, payer reimbursement, cash posting, collections, denials and guarantor collections.
  • Proficient understanding of medical coding systems effecting the adjudication of claims payment. These include ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures.
  • Ability to work collaboratively in a team environment or independently.
  • Must be able to anticipate obstacles to a goal and initiates appropriate resolution.
  • Must have initiative to identify barriers and opportunities and provides solutions through process and operational improvements.
  • Proficient investigation and analytical skills.
  • Able to communicate (both written and verbal) professionally and effectively.
  • Requires exceptional attention to detail and demonstrated ability to prioritize work to ensure accuracy and timely completion.
  • Ability to respond quickly to change
  • Ability to build effective relationships across the System.
  • Must maintain professionalism in all duties and interactions
  • Must be motivated to participate in the continued growth and development of the Revenue Cycle.
  • Proficiency in Microsoft Excel, Word and PowerPoint

Licensure:

  • n/a

Physical Requirements:

  • Lifting up to 20 pounds, standing or sitting for extended periods of time, as well as repetitive use of hands and fingers

  • = Essential functions

At this time Cayuga Health System will not sponsor a new applicant for employment authorization for this position.

If you are interested in applying for this position and you require an accommodation, please contact Cayuga Health System at hr@cayugamed.org

Cayuga Health System Commitment to Diversity, Equity & Inclusion

Cayuga Health System commits to treating all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.

Cayuga Health is dedicated to our vision for diversity, equity, and inclusion. As we strive towards our vision, we welcome the opportunity to work alongside a diverse range of employees.



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