Revenue Cycle Access Analyst I

A Brief Overview

As an essential member of the Revenue Cycle team, Analysts performs, trains and analyzes accurate registrations, patient estimates, point of service collections and provides exemplary customer service while serving the needs of patients and customers. The successful completion of tasks performed by this position, directly impacts denials, customer satisfaction and decreases bad debt. Access Analysts are skilled in patient / physician relations, registration, scheduling and use of multiple, complex systems.

What You Will Do

• Mastery of skills relating to insurance coverage, benefits, rules & regulations and allocation of plans accurate information and fulfillment of requirements resulting in expected payment for services
• Provides daily technical and application support for Revenue Cycle end users
• Creates and distributes end user communication regarding errors, training and workflow changes in a timely manner
• Assists with revenue cycle system build testing and software updates to ensure smooth continued operations
• Performs audits and analysis of transactions to ensure the accuracy of claims, identifies issues, and recommends solutions.
• Audits accounts for accuracy, escalates issues to appropriate team and performs follow up training as needed.
• Utilizes reports and dashboards to ensure staff are meeting quality standards and measures. Communicates needs for improvement to supervisor and manager for follow up with staff.
• Reviews overall department and individual performance through analysis of dashboards, worklists and ADT system.
• Creates training schedule for new hires to ensure staff meet competency skills and assessment
• Maintains access to and serves as administrator for all payer websites, software and specific sites for the Central Business Office.
• Verifies and allocates insurance plans utilizing electronic eligibility tools, phone calls payer, accesses web portals and initiates appropriate action for services including non-covered and out-of-network insurance services
• Executes patient estimate, educates guarantor regarding charges and out-of-pocket liability and establishes payment plan when applicable for professional and technical services.
• Successfully calculates, collects and posts co-pays, deductible, co-insurance and prior balance due from patient in accordance with policy; meets or exceeds collection targets and productivity standards. Takes appropriate steps to balance and secure cash in accordance with UH policy.
• Takes steps to prevent medical record duplications or incorrect patient selection imperative to patient safety; safeguards Protected Health Information (PHI).
• Utilizes electronic reports, worklists, and queues to identify claims requiring updating; makes corrections as needed to ensure accurate and timely billing.
• Verifies insurance benefits / coverage using electronic eligibility tool / phone call; initiates appropriate action to complete a Notice of Admission (NOA).
• Completes daily reconciliation of the Important Medicare Message (IMM) and Medicare Secondary Payer Questionnaire (MSPQ) in accordance to Government regulations.
• Completes daily status changes and revisions in conjunction with the Utilization Management Team.
• Completes patient (face-to-face / phone / via document) and utilizes multiple complex applications to create (or validate existing) patient medical record and insurance / bill claim using demographic and insurance information as needed by department
• Scans and retrieves appropriate related documents in scanning applications
• Follows department policy and procedures, attends and participates in corporate and local team meetings and maintains patient / physician confidentiality.
• Maintains emergency preparedness knowledge / skills needed to participate in drills / disaster exercises and real time safety events.
• Performs other related duties as assigned and participates in enterprise special projects as needed.

Additional Responsibilities

Qualifications : Education

Work Experience

Knowledge, Skills, & Abilities

Physical Demands

Travel Requirements