Healthcare Revenue Cycle Specialist

2 weeks ago

Hasbrouck Heights, New Jersey, United States Hackensack Meridian Health Full time

Position Overview:

At Hackensack Meridian Health, our employees are integral to our mission of enhancing patient care and community well-being. We foster a culture of teamwork and support, ensuring that our staff thrive while delivering exceptional healthcare services.

As a Revenue Cycle Analyst, Physician Billing, you will play a crucial role in providing analytical and financial insights that empower management to effectively oversee accounts receivable operations. Your expertise will be vital in identifying trends and discrepancies in accounts receivable, as well as in supporting the Revenue Cycle team and Practice Management in optimizing revenue flow.

Key Responsibilities:

  • Engage in weekly meetings to analyze denial trends and present findings to the Revenue Cycle team, facilitating root cause analysis and identifying areas for improvement.
  • Lead training initiatives to ensure all team members are well-versed in established protocols and procedures.
  • Conduct thorough reviews of denial cases to support various departments, identifying root causes and recommending strategies to mitigate future occurrences.
  • Monitor changes in billing regulations and processes that may impact cash flow, communicating necessary updates to management.
  • Collaborate with the Training department to develop educational resources based on identified improvement opportunities.
  • Work alongside department managers to refine processes and workflows based on operational trends.
  • Process patient and insurance refunds, ensuring accuracy and compliance.
  • Prepare comprehensive reports on denial trends and payment variances, facilitating discussions with relevant departments to enhance revenue management.
  • Act as a Subject Matter Expert (SME) for complex denial cases, providing insights on contracts and reimbursement metrics.
  • Utilize and enhance reporting tools within the current information systems to achieve optimal reporting outcomes.
  • Analyze manual adjustment reports to identify trends and recommend improvements to the revenue cycle.
  • Conduct audits to ensure compliance with departmental procedures and regulatory guidelines.
  • Monitor payment discrepancies and initiate analysis to address denial reasons, collaborating with Managed Care and other stakeholders as necessary.
  • Facilitate meetings with external vendors to discuss revenue flow challenges and propose solutions.
  • Oversee account work queues, analyzing performance metrics and implementing corrective actions as needed.
  • Assist in the management of Epic systems related to billing and operational enhancements.
  • Perform additional duties as assigned, adhering to organizational competencies and standards.

Qualifications:

  • Bachelor's degree or equivalent experience in a related field.
  • A minimum of 4 years of relevant work experience.
  • Strong analytical, mathematical, and reporting skills.
  • Proficiency in hospital billing systems and Microsoft Office or Google applications.
  • Excellent communication and interpersonal abilities.
  • In-depth knowledge of billing requirements and regulations for major payers.

Preferred Qualifications:

  • Bachelor's degree in a relevant field.
  • Experience in the healthcare sector.
  • Familiarity with Managed Care contracts, Medicare, and Medicaid.
  • Proficiency in Epic and other hospital billing systems.
  • Understanding of ICD-9/10 coding and medical terminology.

Licenses and Certifications:

  • Certification in Epic HB Fundamentals within the first six months of employment.
  • Certification in Epic HB Insurance Follow-Up within the first three months of employment.
  • Successful completion of the EPIC assessment within 30 days of granted access.

If this position aligns with your skills and experience, we encourage you to consider this opportunity.

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