What are the responsibilities and job description for the REVENUE CYCLE ANALYST, REVENUE CYCLE ADMINISTRATION position at SGMC Health?
Description
Location: SGMC Patient Financial Services
Department: REVENUE CYCLE ADMINISTRATION
Schedule: Full Time, 8 HR Day Shift,
Position Summary
The Revenue Cycle Analyst must have a strong working knowledge of hospital and physician practice revenue cycle processes. This position is familiar with various reimbursement methodologies used by payers and is able to verify the appropriateness of the reimbursement received from third party and government payers. This position is responsible for maximizing reimbursement by performing any combination of the following tasks: assuring payments are made according to contract; validating contract build in Epic following updates; collaborates with Hospital Billing (HB), Professional Billing (PB) and Revenue Integrity to assure billing meets payer requirements as defined in their contracts; and works with Denials Team to monitor and evaluate all denial activity from a contract/regulatory perspective. This position is responsible for HB and PB contract management. The Revenue Cycle Analyst is expected to stay current with regulatory and compliance topics from publications including CMS transmittals and Local Coverage Decisions (LCDs) and to communicate updates to appropriate departments.
Knowledge, Skills & Abilities
On-site business setting, indoors. Remote workers are required to have a designated appropriate and safe workspace that ensures their productivity while maintaining the security of health system information. Moderate/high stress level. On-site moderate noise level. Occasional overtime required. Ability to sit, stand, or walk for moderate periods. Reading of printed materials. Listening and verbally responding to customers, staff, physicians, and visitors. Moderately heavy lifting (0-25 lbs.), reaching, stooping, pushing, puling, bending, and twisting. Exposure to all adult ages and socio-economic backgrounds.
Location: SGMC Patient Financial Services
Department: REVENUE CYCLE ADMINISTRATION
Schedule: Full Time, 8 HR Day Shift,
Position Summary
The Revenue Cycle Analyst must have a strong working knowledge of hospital and physician practice revenue cycle processes. This position is familiar with various reimbursement methodologies used by payers and is able to verify the appropriateness of the reimbursement received from third party and government payers. This position is responsible for maximizing reimbursement by performing any combination of the following tasks: assuring payments are made according to contract; validating contract build in Epic following updates; collaborates with Hospital Billing (HB), Professional Billing (PB) and Revenue Integrity to assure billing meets payer requirements as defined in their contracts; and works with Denials Team to monitor and evaluate all denial activity from a contract/regulatory perspective. This position is responsible for HB and PB contract management. The Revenue Cycle Analyst is expected to stay current with regulatory and compliance topics from publications including CMS transmittals and Local Coverage Decisions (LCDs) and to communicate updates to appropriate departments.
Knowledge, Skills & Abilities
- Undergraduate degree in healthcare, business, or finance preferred
- Must have at least 5 years progressive, related experience in healthcare
- Knowledge of various reimbursement methodologies (FFS, DRG, OPPS, IPF, IRF, etc)
- Prior HB and PB billing and/or insurance claim payment experience required
- Contract management skills that include modeling and variance reporting
- Knowledge of medical terminology, ICD-10, UB revenue codes, CPT/HCPCS coding, certified coder preferred
- Proficient using Microsoft Office applications used for communication, documentation, planning, and coordination (Outlook, Word, Excel, PowerPoint, Visio, Teams, etc.)
- Experience working with the Epic EHR desired
- Excellent organizational and project management skills
- Well-developed research skills
- Ability to work independently and effectively handle multiple, concurrent priorities and workloads
- Interpersonal ability and professional demeanor to regularly interact with insurance companies, physicians, and other hospital personnel to effectively communicate processes and resolve issues
On-site business setting, indoors. Remote workers are required to have a designated appropriate and safe workspace that ensures their productivity while maintaining the security of health system information. Moderate/high stress level. On-site moderate noise level. Occasional overtime required. Ability to sit, stand, or walk for moderate periods. Reading of printed materials. Listening and verbally responding to customers, staff, physicians, and visitors. Moderately heavy lifting (0-25 lbs.), reaching, stooping, pushing, puling, bending, and twisting. Exposure to all adult ages and socio-economic backgrounds.
