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Revenue Cycle Denials Analyst

2 months ago

Mt Vernon, United States Skagit Regional Health Full time

The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Other information:

*Job Summary*
The revenue cycle denials analyst will join the revenue cycle team and will contribute to the teams overall goal of strengthening the financial health of the organization. The role will proactively analyze denials data to identify improvement opportunities and support developmental projects as needed. Liaising between the organizations revenue cycle and operational departments, the position will use a data driven approach to communicate with and educate clinical teams on matters of revenue cycle relevance. The Revenue Cycle Analyst will identify trends, collaborate with and develop strategies for Revenue Cycle team members to successfully fight denials.
The incumbent is expected to work with all levels of the organization across diverse areas to implement solutions driving process improvement and reduction of denials. Experience working with Hospital/Healthcare Revenue Cycle processes including reimbursement methodologies and Payer relations is required.

*Essential Functions*
Is responsible for managing and tracking claim denials related to medical necessity, prior authorization, non-coverage, coding error, referral, and other issues as assigned.
Carries out appropriate research and analysis to help with the appeals process and stay informed with best practices and policy changes.
Compiles various reports for revenue cycle and health system leadership, including the status and results of denials and appeals.
Tracks the kinds of claims denied and finds their root causes. Promotes interdepartmental coordination for finding solutions and offers suggestions for improvements.
Makes recommendations to improve processes and lessen the denials rate by suggesting additions, modifications, or deletions to work queues and claim edits. Participates in the testing of system modifications; collaborates closely with department managers and IT personnel to guarantee appropriate implementation.
Conducts clear, concise, and professional correspondence with payers and other stakeholders in accordance with organizational processes and expectations.
Examines payer correspondence and determines potential loss of reimbursement in relation to prior authorization requirements. In case of authorization related denials, submits retro authorizations in line with payer criteria.
Complies with accreditation/compliance standards, state and federal laws, and Skagit Regional Health's rules, particularly those pertaining to HIPAA, fraud and abuse, and confidentiality.
Serves as the primary point of contact for answering revenue cycle-related queries from hospital and clinic leaders.
Performs thorough analysis on revenue cycle denials for assigned departments.
Schedules meetings with clinical leadership/stakeholders on a recurring basis and presents department-specific performance data to them.
Develops action items and/or follow-up plans in collaboration with revenue cycle and health system leaders and ensures completion within specified time frames.
Engages stakeholders from revenue cycle and other support departments as needed to develop and implement comprehensive projects aimed at improving performance of assigned clinical departments.
Identifies trends in individual department performance and facilitates bidirectional conversations with them focused on mitigation of the root cause.
Stays updated on federal, state and organizational revenue cycle compliance regulations, including but not limited to those involving clinical documentation, charge capture, coding and billing.
Collaborates with Revenue Cycle leaders to prepare for and leads the Denials Committee Meetings.
Performs other duties as required which can also include Administrative duties including tracking and trending data, coordinating meetings and invitations. Adheres to all SRH policies and department/location specific policies and procedures.

*Education*
Bachelors degree in billing, finance, accounting, data analytics, or related field required.

*Experience/Training*
Minimum of five (5) years of medical billing and/or patient accounting experience in a clinic or hospital setting required. Minimum two years of experience interdepartmental/multi-facility system preferred.

*License/Certifications*
Revenue Cycle Certification such as, Certified Revenue Cycle Representative (CRCR) and Certified Revenue Cycle Professional (CRCP) strongly desired.

*Other Skills*
Excellent verbal, written & interpersonal communication skills. Must present a professional demeanor, encourage participation & collaboration in an open approachable style with both internal & external customers, be proactive, highly organized, detail oriented & able to respond in an accurate and timely manner to project management needs. Must have strong analytical/problem solving skills in order to assess project needs and develop multiple scenarios for solutions. Must have solid judgment and take personal responsibility and ownership of all work performed, enjoy working in cross-department environments and obtain an understanding of all functions within the teams. Must be resourceful, innovative, confident, and credible with a high level of integrity. This position requires flexibility in the number of hours worked to achieve organizational goals. Ability to provide high level of customer service to both internal and external customers in a professional, service-oriented manner. A successful incumbent will be able to work independently and collaboratively.

*Physical Demands and Work Environment*
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.

*#INDADMIN*

Job Type: Full-time

Pay: $31.77 - $47.66 per hour

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Day shift

Experience:
* ICD-10: 1 year (Preferred)
* Medical billing: 5 years (Required)

Ability to Commute:
* Mount Vernon, WA 98273 (Required)

Ability to Relocate:
* Mount Vernon, WA 98273: Relocate before starting work (Required)

Work Location: In person

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