Healthcare Financial Senior Analyst

Job Description

Job Description

Description:

Reports to: Bill Review Director

Direct Reports: None

FLSA: Hourly, Non-Exempt

General Summary: Review medical billing and clinical medical records for documented services, correct coding and billing, and prepare comparative data analysis and written reports. The Healthcare Financial Senior Analyst provides leadership and support for the Bill Review Team by acting as a subject matter expert, training new team members, creating, and maintaining team processes and procedures, assisting team members to resolve problems, and modeling a positive attitude and work ethic.

Essential Functions

• Ensure all team members are trained on the Bill Review process and guidelines.
• Creates and/or maintains a standard operating procedure (SOP) booklet or file to ensure process integrity is maintained throughout personnel turnover and shortages.
• Deconflict situations between team members or with a client.
• Reviews clinical medical records for supporting documentation of billed charges.
• Provides coding review feedback to medical bill review expert witness consultants.
• Uses medical services valuation methods and benchmarks to determine reasonable value of services provided and analyzes future surgical cost estimates and life care plans.
• Provides written reports thoroughly explaining the reasonable value analysis.
• Contributes thoughtfully to a growing team of professionals who respect each other and promote each other in providing a unique and significant service to our healthcare system.
• Continuously monitors, reviews, and refines internal processes within the Bill Review Team to maximize efficiency, quality, and client satisfaction.
• Assists team members in finding solutions to problems and ensure information flow between teams, raising concerns to the Department Director or Manager as needed.
• Maintain professionalism and adhere to all Medical Equation policies.
• Additional duties, responsibilities and projects as assigned.

Competencies

• Leadership Ability to organize and motivate team members toward a common goal through facilitating cooperation and appropriate delegation of duties.
• Problem-Solving - Resolves problems by identifying the information needed, considering multiple sides of the issue, and creating a logical approach for an appropriate solution.
• Critical Thinking - Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Analytical - Uses a logical reasoning process to break down and work through a situation, data, or problem to arrive at an outcome.
• Communication - Actively listens and provides regular, consistent, and meaningful information and expresses the message effectively by organizing and delivering information appropriately.
• Customer Service - Commitment to delivering high quality service by adjusting priorities, anticipating next steps, meeting client needs, and continuously striving to ensure their satisfaction.
• Organization - Determines priorities, schedules activities allocating and using resources effectively and efficiently.
• Detail-Oriented - Achieves thoroughness and accuracy when accomplishing a task through concern for all the areas involved with the ability to verify the correctness or error in each individual part of procedure.
• Time Management - Manages time by prioritizing and organizing workload to achieve maximum productivity and adjusting as situations change.
• Flexibility - Open to new ideas, a fast-paced and often-changing environment, and new information or assignments. Changes methods of approach when necessary to achieve a goal.
• Teamwork - Promotes and facilitates cooperation and commitment within a team and across teams to achieve goals and deliverables.
• Positive Attitude - Willingness to learn with a "can-do" mindset.
• Discretion - Is able to be discreet and maintain the security of customer and company information.

Required Experience

• Demonstrated experience communicating effectively and providing expert-level customer service.
• Knowledge of payment mechanisms and ability to research as needed.
• Knowledge of conducting and reporting on comparative analyses in the field of healthcare finance.
• Knowledge of medical coding and billing; CPT and HCPCS billing and claims processing.
• Knowledge of payment contract elements.
• Knowledge of a variety of medical service types and how they get paid; Propensity to learn payment rules for hospital inpatient/outpatient services, ambulatory surgical center services, physician office services, pharmacy, DME, ambulance, rehab, etc.
• Knowledge of CMS, Workers Comp and billing charge indexes or propensity to learn them.
• Knowledge of analyzing ratios of charges to benchmarks.
• Knowledge of consolidating billing and valuation data and writing reports to explain the valuation of a provider's charges so that a judge and jury can understand.

Education

• College Degree and industry certification preferred.
• A high school diploma or equivalent (extensive related experience may substitute for certification in a candidate with high school diploma only).

Work Environment

This job operates in a professional office environment. This is largely a sedentary role. The role routinely uses standard office equipment such as computers, phones, and photocopiers.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms. The position requires the ability to occasionally lift office products and supplies, up to ten (10) pounds.

Travel

Travel may be required for this role up to 10%.

Equal opportunity

Medical Equation is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics.