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Revenue Cycle Analysis Specialist

2 months ago

Stockton, California, United States Touro University Full time

Position Overview:

The Revenue Cycle Reporting Analyst will operate under the general oversight of the Director of Business and Clinic Operations. This role is crucial for ensuring that patient billing and payment processing are executed promptly and in line with established policies. The Analyst will work to reduce bad debt, enhance cash flow, and efficiently manage accounts receivable. This position will provide essential support to management for all revenue cycle functions throughout the organization, including front desk operations, outpatient billing, hospital billing, collections, and training for staff and physicians.

Key Responsibilities:

  • Engage in program and service evaluation activities, facilitating adjustments in service delivery based on Continuous Quality Improvement outcomes (e.g., Denial Management, MIPS, HEDIS).
  • Compile and generate various status reports for management to analyze trends effectively.
  • Assist in the preparation of monthly, quarterly, and annual financial reports in collaboration with Corporate Leadership.
  • Ensure data integrity within the practice management system, including charge and collection reconciliations, and report issues to the Supervisor or designated personnel promptly.
  • Provide weekly updates on outstanding charges exceeding 90 days as per the Accounts Receivable Aging report.
  • Report on the status of credit balances through the Unapplied Credit Analysis Report.
  • Monitor gross charges to assess the need for annual fee schedule updates and communicate findings to Corporate Leadership.
  • Facilitate the annual update of the RVU Schedule and Fee Schedule in the EMR, ensuring accurate calculations based on the annual CMS Update.
  • Regularly monitor the volume of Open Encounters to confirm timely entry of all outpatient and hospital encounters.
  • Maintain communication with healthcare providers weekly regarding open encounters.
  • Ensure timely processing and correction of Claim Edit and Rejection Reports from the EMR and Clearinghouse, along with managing rejected claims.
  • Evaluate coding practices among providers to identify patterns of undercoding or irregularities through pre-claim chart scrubbing.
  • Keep updated information on billing and collections processes for each third-party carrier in a Billing Manual.
  • Identify patterns in remittance advices indicating improper collection of insurance information and coordinate retraining or corrective actions as necessary.
  • Address performance deficiencies in healthcare providers and staff identified through internal audits in collaboration with the Supervisor.
  • Maintain confidentiality of all patient Protected Health Information (PHI) and adhere to the Employee Confidentiality Statement.
  • Actively participate in and comply with all aspects of the Corporate Compliance Program, following the Program Code of Conduct and relevant laws.
  • Engage in Continuous Quality Improvement initiatives and other internal committees or projects that enhance organizational performance.
  • Adhere to scheduled work hours, including breaks and lunches.
  • Perform additional duties as assigned.

Supervisory Responsibilities:

Indirect supervision of Clinic Billing Staff.

Qualifications:

  • Ability to function with minimal direct supervision.
  • 2-4 years of progressive experience in medical billing is required.
  • A Bachelor's degree in Finance is preferred or equivalent experience.
  • Dependability and professionalism are essential.
  • Proficiency in using personal computers and various applications necessary for job execution.
  • Knowledge of quality management processes is beneficial.
  • Ability to establish and maintain effective working relationships.
  • Demonstrated sound judgment and discretion.
  • Strong oral, written, and presentation communication skills.

Core Competencies:

  • Exceptional verbal and written communication skills.
  • Strong interpersonal, negotiation, and conflict resolution abilities.
  • Excellent organizational skills and attention to detail.
  • Robust analytical and problem-solving capabilities.
  • Ability to prioritize and delegate tasks appropriately.
  • Integrity, professionalism, and confidentiality in all actions.
  • Familiarity with billing and financial regulations.
  • Proficiency in Microsoft Office Suite or similar software.
  • Experience with Electronic Health Records.
  • Capability to develop programs and lead process improvement initiatives.
  • Participation in strategic planning as requested by Leadership.
  • Ability to implement changes that enhance patient care quality and safety.
  • Commitment to achieving shared goals and promoting cooperative behaviors.
  • Awareness of current healthcare theories, principles, and practices.
  • Knowledge of relevant laws, regulations, and standards.
  • Understanding of organizational, administrative, fiscal, and personnel management principles.

Salary Range:
Maximum Salary: USD $70,000.00/Yr.
Minimum Salary: USD $56,000.00/Yr.