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Business Analyst
4 months ago
Department
BSD UCP - Revenue Cycle - Revenue Capture
About the Department
The University of Chicago Physicians' Group (UCPG) is a component of the physician practice plan for the University of Chicago. The UCPG department provides billing services for medical services provided by University physicians and manages the accounts receivable and reporting processes for the Biological Sciences Division (BSD) departments. Each physician is a faculty member and is based in a specified department in the BSD.
Job Summary
This position is responsible for supporting the Revenue Cycle Team through performance of Provider enrollment activities for the Providers employed by the Advent Medical Group. Network contracts are being updated to include these providers and the Provider Credentialing and Enrollment functions are moving under UChicago. The position is the point person for working with departments, payers other external entities to obtain the necessary information to complete enrollment thereby enabling billing for provider services.
The position also performs billing workflows (e.g. investigate billing or authorization issues related to provider enrollment or resolve Payer system edits related to provider enrollment, etc.) to review/resolve complex provider enrollment issues. Accurately completes data in Provider Enrollment Software to support Roster creation and submission to Payers.
This position is able to work remotely.
**Responsibilities**:
- Oversees day to day operations for Provider Enrollment functions for assigned providers.- Ensures that Provider enrollment data is entered accurately, timely and completely into Provider Enrollment database.- Performs regular Audits to confirm data accuracy and completeness.- Assists with or completes Roster production for payers, as assigned.- Performs re-certification/re-validation of enrollment per schedule mandated by payers.- Troubleshoots and resolves enrollment issues related to claims for provider services. Contacts payers, Departments or other needed resources to resolve. Re-submits claims to payers once enrollment issues are resolved, if needed.- Participate in annual and on-going mandatory compliance training and maintain knowledge of regular updates on billing compliance regulations.- Keep informed of changes in policy by reviewing regular Medicare, Medicaid and other payer bulletins and/or other relevant resources. Be knowledgeable of and continually be in compliance with all federal and state health care laws, regulations, and rules, including Medicare and Medicaid billing requirements that are applicable to the employee's job duties.- Review assigned Provider Enrollment processes and current workflows and provides feedback for suggested changes with the intention to improve, implement, communicate and maintain an efficient Revenue Cycle process.- Prioritizes chart documentation and maintaining requirements within the department. Ensures all processes involved in accurately posting professional fees.- Has a moderate/solid understanding of coding procedures, workflow issues, billing infrastructure, and performance of Clinical Revenue staff. Informs department administrators, physicians, and Coder/Abstractors of regulatory changes.- Participates and may lead in training sessions, performing audits, and promoting an understanding of procedures, policies, and expectations in promotion of compliance efforts.- Performs other related work as needed.
Minimum Qualifications
**Education**:
Minimum requirements include a college or university degree in related field.
- Work Experience:
Minimum requirements include knowledge and skills developed through 2-5 years of work experience in a related job discipline.
- Certifications:
- Preferred Qualifications
**Experience**:
- Three years previous experience with physician revenue cycle and payers or provider enrollment.- Previous experience using physician billing/revenue cycle software and electronic medical records systems strongly preferred.- Prior experience with Epic and/or MDStaff software is strongly preferred.- Previous experience and working knowledge regarding third party payer rules, procedures and policies in Provider Enrollment and Billing is strongly preferred.
Licenses and Certifications:
- Post high school certification/training related to Revenue Cycle strongly preferred.
Preferred Competencies- Demonstrated ability to interact and communicate with clarity, tact, and courtesy with patrons, patients, Providers, and other persons within the Organization.- Demonstrated ability to participate as a member of the Team in identifying priorities for the work unit and participate as a member of a work group or team.- Demonstrated ability to communicate effectively in English, both orally and in writing.- Demonstrated ability to recognize and resolve or refer problems and conflicts. Must be able to remain calm and professional when dealing with an upset provider or other customer.- Demonstrated ability
