What are the responsibilities and job description for the Senior Business Operations Analyst position at Children's National Health System?
Description Responsible for collections and / or refunds of highly complex cases. Performs functions necessary to facilitate payment recovery including research, appeals, and follow up. Identify trends, potential resolutions and escalate to manager. Provide data related to reimbursement reductions, overages, delays, and non-payment. Evaluate accuracy of contract modeling, communicate findings, and escalate as appropriate. Participate in payer meetings to resolve issues. Responsible for ensuring solutions implemented and goals achieved. Identify and monitor CMS & payor rule changes and work to ensure compliance. Qualifications Minimum Education
Bachelor's Degree (Preferred)
Minimum Work Experience
5 years Related patient accounting experience required, especially related to denial mitigation and root cause analysis (Required)
Required Skills / Knowledge
Excellent working knowledge of complex contract reimbursement methodologies including transplant, global, APR DRGs among others.
Proven analytical skills including ability to make recommendations based on financial analyses.
Excellent PC skills including advanced skill proficiency in Access and Excel spreadsheet analysis.
Ability to work in a team environment with other analysts, managers, and department leaders.
Proficiency in presentation of analytical results.
Excellent working knowledge of coding & NCCI edits.
Demonstrated knowledge of managed care payer requirements in an acute hospital setting.
Demonstrated ability to facilitate team or group activities.
Excellent verbal and written communication skills.
Demonstrated ability to be flexible and to prioritize workload & decision-making skills.
Ability to analyze workflow for process improvement.
Strong organizational and coordination skills required.
Functional Accountabilities
Account Follow-up and Collections
- Ensure all assigned claims are followed up and / or appealed in a timely manner as per standard operating procedure (SOP); ensure maximum recovery of reimbursement.
- Follow up on all appeals to ensure receipt and processing by carrier and prevent loss to untimely appeal
- Evaluate contract management expected reimbursement and follow appropriate guidelines to report and escalate.
- Evaluate overpayments and process timely as per procedures
- Manage large volumes of line item denials, underpayments, and overpayments, and various appeal deadlines to prioritize workload and maximize reimbursement.
- Ensure written appeals are clear, concise and within timely appeal limits.
- Ensure appropriate supporting documentation is included with appeals.
- Analyze retracted payments to determine appropriate course of action to recover reimbursement.
- Prioritize work to facilitate payment of higher account balances.
Data Analysis and Issue Resolution
Safety
Organizational Accountabilities
Performance Improvement
Organizational Commitment / Identification
Customer Service
Teamwork / Communication
Performance Improvement / Problem-solving
Cost Management / Financial Responsibility
Organizational Accountabilities (Staff)
Organizational Commitment / Identification
Teamwork / Communication
Performance Improvement / Problem-solving
Cost Management / Financial Responsibility
Safety Primary Location : Maryland-Silver Spring Work Locations : Tech Hill 12211 Plum Orchard Drive Silver Spring 20904 Job : Non-Clinical Professional Organization : Finance Position Status : R (Regular) - FT - Full-Time Shift : Day Work Schedule : 8-5pm Job Posting : Oct 24, 2024, 1 : 54 : 52 PM Full-Time Salary Range : 62088 - 103480
