Revenue Cycle Analyst

Work Status Details: Full Time | 80.00 Hours Every Two Weeks
Exempt from Overtime: Non-Exempt
Shift Details: 8-4:30
Department: Patient Financial Services Admin | Reports To: Director-Patient Financial Services & Health Information

The mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care.

Summary:

This position is responsible for ensuring internal billing processes are following current State and Federal Regulations; Stay up-to-date with upcoming changes, and advise leadership of the changes; Collaborate with leadership to implement changes to ensure billing compliance; Detailed analysis and maintenance of the Facility Charge Description Master (CDM) and Physician Fee Schedule; Create reports to analyze payer accuracy and analyze the impact of potential changes in payment methodologies; Track and respond to payer audits; Facility enrollments.

The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.

Responsibilities:

Essential Job Duties and Responsibilities:

1. Demonstrates knowledge of Federal and state standards and laws to maintain corporate compliance for both FRHS and the department.

• • Medicare
  • Medicaid
  • Commercial Insurance
  • Other third-party payors
  • EMTALA
  • JCAHO

2. Ensure Compliance with the No Surprise Act-Pricing Transparency requirements.

1. • Maintenance of the Facility Charge Description Master (CDM) and Physician Fee Schedule. Analyze and audit the Facility CDM and Physician Fee Schedule to ensure appropriate pricing according to internal standards and to ensure maximum reimbursement. Update the CDM and Fee Schedule when appropriate by adding new service code and deleting/deactivating invalid codes.
   • Conduct billing audits to ensure correct billing to include: correct CPT/HCPCS usage, correct Revenue Code usage, appropriate modifier usage, general ledger account routing for all transactions, charge amounts and charge descriptions, and correct payments according to payer contracts.

5. Review annually with Department Directors their charges in the facility billing system with findings and mandated CDM revisions to ensure all changes are incorporated and all chargeable items are captured. Conduct training with new Department Leaders on the process for requesting updates to charges.

6. Ensure charge pricing is in line with industry standards as well as competitive with like facilities based on size, type, and geographical location.

7. Establish and conduct training sessions as need to staff on CDM and coding system.

8. Facilitate the addition or deletion of payer specific billing edits to ensure accurate claims are sent to payers.

9. Work directly with the facility IT department on all Electronic Health Record (EHR) upgrades which also includes implementation and testing.

10. Complete FRHS facility provider enrollment, obtain necessary signatures, and submit completed packages to payors. Complete Out-of-State Medicaid enrollments, and facilitate Provider enrollments as needed. Complete EDI enrollments.

11. Analyze contract proposals and the impact of potential changes in payment methodologies. Propose changes to payer contracts that are in the best interest of Faith Regional.

12. Create and distribute daily, weekly, and monthly reports as assigned.

13. Ensure daily files between early-out and bad debt vendors are sent and retrieved automatically. Collaborate with IT to troubleshoot issues that arise with daily file transfers and SFTP sites.

14. Track and respond to payer audits. Collaborate with the CDI team to locate proof of services provided in the medical documentation and appropriate coding.

15. Update contracts within the EHR to ensure payment variances are identified accurately.

Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other information:

Job Requirements:

The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.

EDUCATION:

GED or High School Diploma preferred.

Associate Degree preferred.

Previous Experience Requirements:

EXPERIENCE:

Previous clinical experience preferred.

Previous healthcare experience preferred.

2 Years of previous experience medical billing or coding preferred.

2 years of report writing/report analysis experience preferred

Combination of two years of education and experience in position field required.

Skills/Knowledge Requirements:

SKILLS:

Ability to read, write, speak, and understand the English language required.

Computer Skills required.

KNOWLEDGE:

Microsoft Office (Word/Excel/PowerPoint) required.

Faith Regional Health Services is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.