Revenue Cycle/Operations Specialist

3 weeks ago

Brooklyn, United States NYC Health + Hospitals Full time

About NYC Health + Hospitals:

Since 1875, South Brooklyn Health has established its reputation for clinical excellence and culturally competent care. It has designations as a Certified Percutaneous Coronary Intervention (PCI) Center, an Advanced Primary Stroke Center, an accredited Baby-Friendly Hospital, a U.S. News & World Report high performing hospital. The hospital's staff is as diverse as the patients they serve. Interpreter services can be provided at any time of the day or night in over 130 languages.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description:

Shift: Tour 2: 9 A.M. - 5 P.M.

Purpose:

Monitor ongoing performance of Revenue Cycle results through the use of key operating indicators (KOI). Use data to identify trends and gaps. Uses dashboards and reports to monitor key performance indicators of revenue cycle workflows and to ensure a holistic view of the revenue cycle. The Revenue Cycle Analyst provides analytic support, problem-solving, and communication with clinic departments on all matters pertaining to revenue cycle needs and key operating indicators (KOIs). Provides a detailed assessment of revenue cycle processes with a focus on process improvement and best practices.

Specific Duties and Responsibilities:

Champions revenue cycle optimization initiatives across South Brooklyn Health to improve processes and support revenue cycle performance.

Need a thorough understanding of systems, ambulatory care coding and billing guidelines to proactively identify opportunities for revenue cycle improvement and work with clinical departments to institute changes.

Assists in developing strategies to improve overall revenue performance

Applies knowledge of coding including use of billable CPTs, diagnosis codes, modifiers, place of service codes, and source codes to perform an in-depth analysis of root cause issues.

Collaborates with the Epic team on EMR optimizations focused on workflow improvements to improve revenue capture.

Performs denials analysis to reduce controllable rejections

Extracts, collates, and refines data from multiple sources to manipulate into one reporting set using excel, BI tools, and other practice management systems

Stays abreast of group payer contracts, payer policies, payer plans, and member benefits

Presents data, analysis, and recommendations for solutions in meetings with departmental management, clinical leaders and senior leadership stakeholders

Participates in training and other in-servicing sessions for end-user education

Reviews and analyzes Explanation of Benefits (EOBs), payer correspondences to identify denials that can be appealed. Perform denials analysis to reduce controllable rejections. Perform deep-dive analysis to find solutions that can benefit multiple specialties.

Prepares a communication plan for audit results and information discovered to relevant stakeholders. Participates in developing best practices for relevant changes.

Develops new report templates for ad-hoc and or standard monthly reports to assist with monitoring of Revenue Cycle Metrics. Provides a detailed assessment of revenue cycle processes with a focus on process improvement and best practices. Monitor and analyze to compare with industry benchmarks

Prepares monthly reports, analysis, and formal presentations for departmental and central administration leadership. Delivers presentations as needed.

Works closely with Department management to facilitate root issue remediation.

Identifies key topics and best practices for optimization and establishes mechanisms to share expertise and knowledge amongst peers.

Serves as liaison between Revenue Cycle Management team and the clinical departments in the coordination of revenue cycle projects and activities.

Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.

Performs other duties and responsibilities as assigned by the CFO and Director of Revenue Cycle Office.

Minimum Qualifications:

1. Masters degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and four (4) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, three (3) years of which must have been in responsible administrative or managerial capacity; or

2. Bachelors degree from an accredited college or university in disciplines, as listed in 1 above; and five (5) years of experience, as described in 1 above, three (3) years of which must have been in a responsible administrative or managerial capacity.

Department Preferences:

1. Build strong relationships and leads effectively through motivation and influence.

2. Data driven and results oriented.

3. Effectively communicates mission and vision.

4. Experience using Microsoft Office (Excel, Word, PowerPoint, Access) and EPIC

NYC Health and Hospitals offers a competitive benefits package that includes:

  • Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
  • Retirement Savings and Pension Plans
  • Loan Forgiveness Programs for eligible employees
  • Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
  • College tuition discounts and professional development opportunities
  • Multiple employee discounts programs

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