Revenue Cycle Analyst
3 weeks ago
Overview:
Our team members are the heart of what makes us better.
At **Hackensack Meridian **_Health_** we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The **Revenue Cycle Analyst, PB** provides statistical and financial data enabling management to accurately monitor accounts receivable activity on an ongoing basis. Identifies issues for management regarding significant changes in various accounts receivable categories reflected in the daily dashboards and denial reports. Supports the Revenue Cycle team and Practice Management by monitoring key metrics related to revenue and accelerated cash flow. This position performs high level analysis of accounts receivable and uses considerable judgment to determine solutions to complex problems. All tasks must be performed in a timely and accurate manner. Meets with appropriate Revenue Cycle leaders and makes recommendations to prevent future denials and payment variances. Disciplines include but are not limited to Patient Accounting, Case Management, Health Information, Clinical, Training, Managed Care, Outsource Partners, Practice Management and DTS. Duties performed are at multiple sites within the Hackensack Meridian _Health_ (HMH) Network.
**Responsibilities**:
A day in the life of a **Revenue Cycle Analyst, PB** at Hackensack Meridian _Health_ includes:
- Participates & Reports on Weekly Graph & Workflow meetings on Denials trending for the Network. Identifies and performs root cause analysis of high-volume denials and underpayments, and presents the findings to the Revenue Cycle team. Communicates improvement opportunities and corrective actions based on findings.
- Act as Team Leader to ensure all team members are trained & aligned with established Desktop & policies & procedures.
- Performs analytical review of denials to support Revenue Operations, Case Management, Access, and other departments as it relates to denials and payment variances. Determines the reasons for denials, meets with appropriate Revenue Cycle leaders and Practice Management, and makes recommendations to prevent future denials and payment variances.
- Identifies problems in process flow or changes in payer's billing rules and regulations and governmental guidelines that slows cash flow and workflow and disseminates information to management.
- Collaborates with the Training department on developing education materials based from the resolutions/outcomes of the improvement opportunities presented at inter disciplinary meetings.
- Collaborates with Department Manager in developing processes and workflows on trends identified on various areas of operation.
- Process Patient and Insurance refund and other overpayment request.
- Prepares trending reports of all high volume denials and payment variances. Meets biweekly and monthly with various departments to communicate findings and recommendations to improve revenue management.
- Works closely with front-end (Access) regarding up-front cash collection, registration, and eligibility denials. Schedules biweekly meetings to resolve issues that will slow cash collection. Respond to Practice Management inquiries.
- SME (Subject Matter Expert) for complex denials and payment variances including contracts, fee schedules, and edits. Educates and provides feedback to various areas on Revenue Cycle metrics and key performance indicators.
- Utilizes and develops new Epic and ad-hoc accounts receivable or denial reporting tools for management, using the current information system and/or other software programs to achieve desired reporting outcomes.
- Tracks and reports on causes of manual adjustments which will be the basis of escalation to Information Technology for contract management corrections.
- Performs staff audits based on manual adjustment reports. Reviews activities to improve the revenue cycle. Ensures that the team is following departmental procedures and are in compliance with governmental and commercial payer guidelines.
- Performs reimbursement management, analyzes payer reimbursement to ensure proper claim adjudication, and tracks and reports on high volume payment discrepancies which will be used as escalation to Managed Care, the payer, or DTS. Monitors payments denials and initiates CPT or DRG analysis to determine reasons for denial.
- Monitors daily dashboard and reports and conducts analytical reviews to determine if changes or enhancements on current policies and procedures are required.
- Participates, schedules, and coordinates meetings respond to inquiries with appropriate personnel to exchange ideas on working towards accounts receivable relat
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