Revenue Cycle Analyst

Job Summary This position contributes and supports Mid Valley Hospital’s mission to strengthen the interface between clinical departments and charge improvement process. This approach guides the organization toward achieving operational efficiency, regulatory compliance and accurate reimbursement. The Revenue Cycle Analyst II is responsible for organizing, analyzing, and presenting data in coordination with clinical and financial management staff to support proper charging practices for all hospital and physician departments, providing accurate, timely, and objective analysis at all times. In addition, this position oversees and maintains the hospital and physician charge master, including charge structure, charge coding, government regulations and compliance, pricing and rate structure. Included in these projects are ongoing and special financial analysis and support to Finance, Administrators, Directors and Managers throughout the facility, as well as other special projects as assigned. The Revenue Cycle Analyst II has extensive internal contact with members of all Clinical departments as well as Revenue Cycle and Finance and all levels of leadership throughout the organization. This position serves as the liaison between Mid Valley Hospital staff and the EHR vendor. Education Background and Experience Minimum Education: Bachelor's degree in a related field or equivalent combination of formal education and experience. Required Licensure / Certifications: None Required Required Experience: Three to five years minimum recent experience in healthcare auditing, charge capture, project management, revenue cycle management, patient accounting and/or physician billing. Preferred Qualifications: Cerner Community Works experience, knowledge of Critical Access Hospital and/or Rural Health Center reimbursement methodology. Professional Requirements Adheres to dress code, appearance is neat and clean. Completes annual organization-required and/or job-required educational requirements. Maintains regulatory requirements. Wears identification while on duty. Attends staff meetings and/or reads all meeting minutes. Reports to work on time and as scheduled, completes work within designated time. Maintains employee/patient confidentiality. Represents the organization in a positive and professional manner. Participates in the department’s performance improvement activities. Demonstrates the mission, ethics, and goals of the organization as well as the departmental Scope of Service. Communication with patients, guests, family, and staff is courteous, respectful, and helpful. Maintains a clean, safe, and accident-free environment. Follows Infection Control procedures at all times. Adheres to the following environmental care standards. Demonstrates adequate knowledge of safety policies and procedures, the use of MSDS sheets, hazardous material procedures, and safety codes. Respond appropriately to any Codes while working any shift (Code Blue, Code Gray, Code Silver, Code Amber, Code Red, Code Orange, and Rapid Response Team). Demonstrates adequate knowledge of security issues, i.e., personal protection, protection of personal and hospital property. Participates in quality initiatives as needed. Be familiar with and comply with the Mid-Valley Hospital & Clinic Personnel Handbook and Policies. Be familiar with the collective bargaining agreement (Union Contract) of the UFCW3000 and Mid-Valley Hospital. Essential Job Functions 1. Maintains and ensures the overall integrity of the CDM (Charge Master) with a focus on accuracy, revenue cycle integrity, and compliance with payor requirements. This includes overseeing audits of the CDM as needed. 2. Responsible for the build of new CDMs on a timely basis. 3. Discover pricing and payor contracting opportunities to positively impact the bottom line. 4. Responsible for the compilation and distribution of the Daily Revenue Cycle Action Team (RCAT) report to the RCAT email distribution to assist in review of charges, correspond with managers/directors on any noted variances for further review. Lead the training of new managers in daily charge review. 5. Daily review of charges mapped to unaliased department(s) or account(s). Review charges posted to Pre-Admit Encounters. Coordinate with Fiscal on any pending interface charge variances in need of review. 6. Lead and/or assist in charge audit review to ensure accurate charge capture and compliance with Payor contracts. 7. Create reports within the EHR and Clearinghouse for auditing purposes, dashboards, price transparency, claim edits, and other denial, payment, or adjustment analysis. Develop and manipulate large data sets. 8. Actively participate in independent chart audits, assisting with review, appeals and addressing corrective action plans as applicable. 9. Facilitate Mid Valley Hospital’s bi-weekly Revenue Cycle Projects Meeting. Areas of focus include Billing, Coding, HIM, and Chargemaster but often involve other departments. Identify stakeholders, moderate discussion, prioritize projects, assign action items, organize and maintain notes. 10. Plan, manage, and coordinate multiple assigned functional projects simultaneously, ensuring stated goals and objectives of projects are accomplished within prescribed time frames and funding parameters, if applicable. Identify and schedule project deliverables, milestones, and required tasks; complete action plan follow up with project participants; and perform other related duties associated with driving projects to successful completion and achievement of business outcomes. 11. Distribute suspended charges daily to the appropriate manager for review and correction. Troubleshoot and resolve any issues as needed regarding charges in status of Suspended, ABN Required, Manual, Statistical Only, Pending. Review and resolve timely to alleviate delays in coding and claim processing.* 12. Navigate and understand the EHR functionality as it pertains to Revenue Cycle and assist in troubleshooting issues. 13. Assist in the research of new service lines as it relates to new CPT codes, price, and billing requirements. 14. Collaborate with Director of Revenue Cycle to create, review and/or update policies and procedures which impact charge capture and pricing practices as needed. 15. Identify, report and participate in the resolution of any potential or actual revenue/charge related issues. Advise department heads and management of possible resolutions and recommended actions. *Responsible for coordination of Charge master and Charge Capture process in researching coding and billing guidelines, payer reimbursement and updating hospital and professional Charge master and Charge Capture processes. 16. Work closely with outside vendors when applicable (e.g. Electronic Health Record, Clearinghouse, etc.). Initiate and manage Help Desk Tickets as they relate to Charge Services. Test EHR solutions in the testing/cert environment. 17. Work with the revenue producing departments to ensure ongoing coordination and consistency with the Charge master and Charge Capture processes, including accurate descriptions, coding, additions, deletions, pricing, revenue code and any other changes. 18. Work with the Chief Financial Officer regarding annual Charge Master increases and responsible for ensuring increases are submitted to Electronic Health Record vendor timely prior to effective date. Review Charge Master price adjustments based on billing rules and competitive pricing. 19. Work alongside the Director of Revenue Cycle and outside vendor to ensure compliance with the Price Transparency Rule. 20. Work with Revenue Cycle to identify/fix errors based on ICD/CPT/HCPCS coding guidelines and National Correct Coding Initiative edits and other industry published rules and regulations. 21. Create Dashboards as requested by the Executive Leadership Team or KPIs initiated for tracking within the Revenue Cycle Team. Maintain the Revenue Cycle KPI Dashboard with monthly data. 22. Create visual presentations of Revenue Cycle material and present to key stakeholders. 23. Demonstrates ability to handle multiple demands, shifting priorities and crisis. Know what information is critical to communicate and who to communicate with. 24. Interact professionally with coworkers and customers at all times and interact effectively as a team contributor on all assignments. 25. Perform quality work with deadlines and/or Key Performance Indicators (KPI)/Statistics with limited supervision. 26. Demonstrate Standards of Behavior and always adhere to the Code of Conduct in all aspects of job performance. 27. Other duties as assigned by the Chief Financial Officer. Act in the interest of the CFO when appropriate to oversee meetings or entire projects. 28. Advanced level root-cause analysis. 29. Interviewing/listening skills required to enable talking with individuals and groups about current processes and issues to ask the right questions to yield essential information that will be used to evaluate processes and determine potential solutions. 30. Well-developed research skills. 31. Knowledge of Microsoft applications including Word, Excel, Outlook, and PowerPoint. 32. Excellent process improvement techniques and project management skills. 33. Capacity to manage time effectively, attention to detail, and follow through. 34. Comfort in presenting to and interacting with senior levels of hospital management and with physician leaders. 35. Advanced analytical skills to evaluate information gathered from multiple sources and synthesize into actionable information. 36. Advanced technical skills to quickly learn hospital information systems. Physical Demands How many hours per work day: 8 On-the-job time is spent on the following activities. Show the amount of time by checking the appropriate boxes below: Amount of time: Sit 2/3 of time Talk or hear 2/3 of time Use hands to finger, handle or feet 2/3 of time This job takes no special vision requirements The typical noise level is Quiet WAGE AND COMPENSATION Wage range: $68,000.00 to 95,000.00 – DOE Mid-Valley Hospital offers a benefit package. This includes accrued vacation time in the amount of .076923 vacation hours per hour worked. Accrued sick leave at an accrual of .04615 per hour, Life insurance and a profit-sharing plan. We also offer medical, dental and vision insurance plans. Employees can enroll in a 403(b) deferred compensation plan and/or a 457 deferred compensation plan. #J-18808-Ljbffr