Responsible for assisting the Revenue Cycle with analysis of key performance metrics. Develops and refines reports that identify problems and highlight potential opportunities. Analyzes third party denials and prepares relevant reports regarding trends in third party payments, denials and rejections. Works with ancillary departments’ staff and third party payor provider representatives to identify source of denials and develop processes to eliminate and/or minimize untimely payments, underpayments, denials and rejections to improve cash flow.
Prepares, mines data, evaluates, resolves, distributes and records statistics accurately and timely. Proficient in the understanding and management of all functions related to third-party billing processes, specializing in hospital and professional fee denial management, and fee schedule reimbursements. Creates and provides regular updates to reports which help identify and correct issues that are negatively impacting revenue. Reviews individual denials to determine why they occurred.
Monitors denial trends and reports; recommends corrective and preventative actions. Produces ad-hoc reports. Actively participates in global revenue cycle initiatives and leads processes affecting operations within revenue cycle
Experience in data analysis/data modeling the ability to analyze data in creative ways and display results in a compelling manner.
Experience with EPIC Enterprise preferred. Knowledge of database management software (Access, SQL).
Strong computer skills; proficiency with Microsoft Office suite. Thorough understanding of ICD-10, CPT codes, HCPCS codes, hospital and physician billing, third party reimbursements and contracts.
Software implementation and project management skills.
Excellent interpersonal skills as well as superior writing skills. Deadline oriented; ability to work independently and in a team environment.
Ability to manage multiple complex and concurrent projects.
BS/BA in Business or Finance preferred; Equivalent work experience (3 years healthcare revenue cycle) acceptable in lieu of degree