Systems Analyst
21 hours ago
Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation Medicine, Renal and Mental Health Services.
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.
Work Shifts
8:00 A.M - 4:00 P.M
Job Description
A member of the revenue cycle process, the Systems Analyst, is responsible for supporting the Patient Accounts Department in planning, designing & evaluating activities. The Systems Analyst participates in project implementation through research, analysis & follow-up activities & other appropriate duties, as assigned. The Systems reports to the Assistant Coordinating Manager.
Duties & Responsibilities
• Maintains IPRO/ESMSEF Mailgate Portal for Elmhurst IPRO Medicaid Cost Outlier correspondences, reroutes emails to appropriate staff, processes all incoming IPRO/ESMSEF correspondence: Technical Denials, DRGs, Predenial, Final, Utilization Reviews, Determinations, Approvals & all other correspondences related to Medicaid Cost Outlier cases & uploads all Hospital responses to IPRO/ESMSEF Mailgate portal & communicates to supervisor portal issues.
• Process all Medicaid Cost Outlier correspondence related to: Technical Denial, Initial Request, Appeal/UR/DRG Determination, Approval, Predenial, Final, Waiver & uploads all Hospital responses to Medicaid Cost Outlier denials to IPRO/ESMSEF Mailgate portal.
• Lead on Medicaid Cost Outlier DRG workflow, processing correspondence, communicating with HIM & staff & uploads Hospital DRG correspondence to IPRO/ESMSEF.
• Prepares responses, identifies findings & issues for the Medicaid Cost Outlier appeals process under the guidance of the Principal Hospital Care Investigator & the Assistant Coordinating Manager & assists with reports from Central Office.
• Performs data entry in the Medicaid Cost Outlier Access Database & Epic H2O, creates reports, communicates issues & maintains wellness of database, uploads to OnBase & updates Access Database & Epic H2O.
• Support administrative workflow in receiving, processing & managing responses to CMS Medicare RAC Performant denials & communicating with staff, checks Performant portal & communicates with Supervisor any issues.
• Prints eMedNY paper form 150003, relates to Supervisor any issues.
• Apply quantitative research & collect, classify, analyze & summarize data; prepare recommendations concerning assigned projects.
• Perform research & other information gathering activities & prepare these materials for input into reports for sharing & review at team meetings.
• Prepare drafts of reports, memorandums & other correspondence dealing with planning on assigned projects.
• Attend all necessary training sessions to effectively perform the day-to-day functions of the position.
• Participate & support projects identified by Assistant Coordinating Manager and Principal Hospital Care Investigator in the support of the Patient Accounts Department's Medicaid Billing & Follow Up Unit.
Minimum Qualifications
1. A Baccalaureate Degree in Industrial Engineering, Systems, Industrial Management, Business Administration or related fields; or,
2. Two years of technical training or education beyond the High School level with a minimum of two years of full-time, paid experience in the field of industrial engineering, systems analysis, methods and procedures, work simplification, cost reductions, EDP data processing applications, forms design and control; or,
3. A satisfactory combination of the above
Department Preferences
EDUCATIONAL LEVEL:
- A Baccalaureate Degree from an accredited college or university in Business Administration., Engineering or Social Science, Health Care Specialization, Physical Sciences or related program; or
- High School graduate with four years of experience related to Health Care Program Planning, Research, Design, Operation, Evaluation and Analysis
- Basics of Hospital's Revenue Cycle & general principles of hospital's billing & follow-up requirements.
- Strong communication skills (written & oral);
- Strong time management skills;
- Computer literate;
- Prior experience working within electronic medical record & financial management system in hospital or physician office setting
- Desktop PC; laptop; scanner, all-in-one (printer/scanner/fax)
- EPIC EMR & Financial Management System
- On-Base & Media Manager for Scanning
- Secure Payer Portals (e.g. Mailgate for IPRO)
- MS Excel, Word, Access, PowerPoint
- Adobe Acrobat
- Satisfactory combination of education, training & experience.
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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