Revenue Cycle Process Improvement Systems Analyst

Scope of Position

The Revenue Cycle Process Improvement Systems Analyst serves as an internal consultant supporting and driving implementation of the revenue cycle improvement initiative using a structured industry approved approach. This position is supportive of all revenue cycle process improvement strategic initiatives.

Position Summary

The Revenue Cycle Process Improvement Systems Analyst is also responsible for a wide variety of functions that primarily revolve around analyzing and resolving issues with accounts that involve authorization, billing, and compliance. This position serves as an expert in understanding the payers requirements and works with various other departments to identify issues and resolve them prior to billing or after a denial is received. This position is responsible for providing a higher-level review of all medical necessity and authorization denials to determine a root cause for the denials. This position analyzes data to identify historic trends, perform comparisons against identified standards, and assists in formulating strategic plans for appealing denials.

This position uses expert knowledge of payer authorization requirements to write and submit appeals for administrative authorization denials. Identifies and develops appropriate tools to track issues, analyzes workflows, identifies logistical and operational issues to target for improvement. Further, this position is responsible for reviewing accounts with various claim errors that require a second higher-level/comprehensive review. This can include claims with admission or discharge date discrepancies, admission order timing issues, or various other regulatory compliance issues. This position is also responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle and serve as the primary trainer for onboarding peers with less experience. This position must apply industry knowledge and a thorough understanding of all available systems where revenue cycle information is held, including Midas and EPIC modules for Cadence, ADT, Ambulatory, and Resolute.

MINIMUM REQUIRED QUALIFICATIONS

Bachelor's degree or equivalent experience. Advanced degree in relevant field may be desirable. 4 years of relevant experience required. 4-8 years of relevant experience preferred.