Senior Revenue Cycle Analyst

Senior Revenue Cycle Analyst

A senior revenue cycle analyst at Madison Health is responsible for providing data analytics and system support for revenue cycle IT systems to improve various functions within revenue cycle management, including charge capture, billing, coding, payment posting, and denial management. The analyst will function as a project manager, collaborating closely with subject matter experts in their respective departments to facilitate day-to-day business operations, productivity improvement programs, revenue reconciliation, benchmarking, and reporting. Candidates should have a thorough understanding of the overlap and interaction between administrative and financial IT systems, along with a thorough familiarity with electronic health record systems and other underlying systems and databases are integral to the EHR.

• Evaluates and validates revenue data, trends, and key performance indicators to identify revenue cycle improvement opportunities. Uses reporting tools like Epic and Excel to provide data-driven insights.

• Acts as a subject matter expert, supporting internal team members and external stakeholders.

• Creates various reports to evaluate individual revenue cycle areas, such as accounts receivable. Prepares monthly reports and dashboards for monitoring of revenue cycle key performance indicators.

• Oversee the regular updates, additions, and deletions of billable items in the chargemaster. Ensure all CDM entries mapped to correct CPT/HCPCS and revenue codes, adhering to third-party and CMS guidelines.

• Conduct routine audits to identify missed revenue opportunities and implement corrective measures.

• Monitors and assesses various EHR work queues, answers questions submitted by revenue cycle operations.

• Analyze root causes for charge/claim edits, claim rejections, and insurance denials to adjust workflows and prevent future errors.

• Conducts daily, weekly, and monthly reconciliation procedures to identify posting inconsistencies; directs the information to the respective department for rectification. Prepares reconciliation documents for finance teams.

• Initiates proactive research and resolution of issues. Examines current and future state processes and provides guidance to leadership on problem-solving.

• Works with cash management to resolve challenges and adapt to industry trends and changes in payer processes.

• Ensures all workflows and data management within revenue cycle IT systems maintain patient privacy and abides by HIPAA regulation.

• Education: Bachelor's degree in accounting, finance, health information management, computer science, informatics, or related field preferred.

• Experience: Minimum 3-5 years of experience in CDM management, health information management, or hospital revenue integrity. Experience with Epic electronic health record system, including report functions and add-on functions required. Experience in healthcare billing requirements (UB-04 and 1500) and CMS Medicare and Medicaid reimbursement methodologies required.