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Revenue Cycle Analyst

Finance | Emeryville, CA | Full Time, Contract, and Temporary

Job Description

Revenue Cycle Analyst - Service Line Specialist 629748

The Service Line Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture/charge description master processes. This position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services. This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities. The Service Line Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas; department charge capture education, charge audit activities, charge description master management, and monitoring of charge capture related metrics.

Responsibilities:

  • Charge Capture
    • Liaisons with departments to thoroughly define reporting and information requirements.  
    • Identifies data source, develops and delivers routing and ad-hoc reports and presentations. 
    • Acts as the charge capture subject matter expert and initial contact to assigned clinical areas.  
    • Evaluate revenue cycle inquiries and propose improvements or enhancements to system to maximize revenue.
    • Conducts and evaluates annual charge capture reviews and workflows to ensure consistent principles with coding, nomenclature and pricing for assigned cost center and/or new department creation. Collaborates with departments to design new workflows and conducts charge validation in order to maximize revenue. 
    • Regularly reviews and updates charge capture related policies and procedures for assigned clinical areas. 
    • Provides timely educational intervention in support of charge capture processes. Develops training materials for clinical area use and reference.
    • Conducts and leads regularly scheduled, on-site meetings with assigned service line clinical departments to ensure accurate and charge capture practices and workflows are in place; including daily charge reconciliation.
  • Revenue / WQ Monitoring and Oversight
    • Monitors gross revenue metrics against established benchmarks for assigned cost centers; assist clinical department to identify revenue variance root-causes and mitigation of discovered issues and communicates to Service Line Special Lead and Revenue Integrity Manager.
    • Applies dashboard and other processes for continuous analysis of complex revenue cycle functions of diverse scope.  Audit data input for validity and accuracy.
    • Work proactively with departments across the system to assure appropriate revenue cycle practices and compliance with internal and external regulations.
    • Performs daily review and monitors clinical department work queues and provide assistance to department representatives to resolve issues, as needed.    
    • Actively resolved edits routing to Revenue Management owned work queues, performed ongoing trending and root-cause analysis. 
  • Other
    • Independently generate reports and analyze complex financial data.  
    • Identifies trends in revenue cycle operations and presents reports to all levels of hospital management and physician leaders.  
    • Collaborates with the Revenue Integrity CDM Manager to support ongoing CDM updates, preference list maintenance, or charge interface charging mechanisms.
    • Coordinates system related upgrades or application updates between assigned clinical areas and Information Technology department.
    • Collaborates with Advisory & Audit Services, Compliance, other internal/external auditor(s) to review results from retrospective and concurrent audits, develop an action plan to resolve discovered issues, and ensure implementation.
    • Engages Patient Financial Services (PFS), Health Information Management (HIM), and other departments to determine denials and work queue edits and mitigation plans.
    • Monitors and completes assigned tickets.  
    • Ensures tickets are completed to the satisfaction of the end user.
    • Reviews Medicare intermediary and third-party payer bulletins, memos and websites to keep current on coding requirements, pending changes, and communicate relevant information to all applicable departments.
  • Performs other duties as assigned and appropriate to the position.

Requirements:

  • Four (4) to six (6) years of experience in clinical charge capture, charge description master, coding, government/third-party reimbursement, or similar healthcare experience
  • Bachelor's degree in related area and/or equivalent experience /training.
  • Master’s degree in related area and/or equivalent experience/training preferred
  • Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle, specifically revenue integrity, and its component operations, including billing, coding, collections, charge capture, contractual adjustments, third-party reimbursements and compliance.
  • Experience in managing and/or developing charge description master or charge capture processes, policies, and/or procedures.
  • Knowledgeable in use and application of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Revenue codes.
  • Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle.
  • Detail-oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities and effectively address complex, urgent issues as they arise.
  • Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management.
  • Skills in common database, spreadsheet and presentation software.
  • Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner.
  • Ability to prepare compelling and informative reports and presentations.
  • Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions. 
  • Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.
  • Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on complex regulatory changes, and industry trends and developments in revenue cycle management.
  • Practical experience using hospital information systems, Epic billing system preferred, and computer proficiency with PC applications (e.g. Microsoft Office).

$35 per Hour        Emeryville, CA 94608          3 Month Assignment