Sr Analyst – Revenue Cycle

Sr Analyst – Revenue Cycle

Requirements

• Knowledge of medical terminology
• Experience in health care accounts receivable follow-up
• Thorough understanding of the health claim revenue cycle workflow process
• Education minimum of Associates degree, Bachelor’s degree preferred
• Knowledge of reading and interpreting insurance Explanation of Benefits (EOB) statements
• At least 2 years of working on coding denials, and understanding of NCCI edits is preferred
• Solid understanding of insurance guidelines and principles, including COB, HIPAA, CPT, ICD-10, Medicare and managed care plans
• Proficiency in reading proper insurance plan and policy# from insurance ID cards
• Time management skills and the ability to meet deadlines is imperative
• Excel/Google Sheets experienced preferred
• CPC credential is a plus
• Database query or business analyst experience a plus
• US work authorization

Responsibilities

• Possess strong critical thinking and problem-solving skills to work through complex payer issues within claim denials, underpayments and/or missing payments
• Work with billing vendor to monitor timely claim submissions and posting payments
• Follow up with insurance companies on claim denials and submission of claim corrections
• Experience using available tools (websites, electronic medical records, and payer systems) to efficiently complete eligibility lookups, claim inquiries, create/maintain admin and user accounts for new and terminated employees
• Contact payers to obtain clarification and/or details regarding incorrect payment/denials
• Maintain working knowledge of company policies for collections, adjustments and write-offs
• Effectively work edits from a claim scrubbing software (NCCI, Custom payer rules etc.)
• Analyze data from billing vendor and/or business intelligent department to identify trends and create reports for management
• Extract details from medical records to substantiate billing/coding changes
• Serve as a liaison between administrative and clinical staff within our clinics to resolve billing questions
• Communicate effectively using helpdesk ticketing system to research clinic inquiries regarding patient statements and/or account balances
• Identify process improvements and escalate to management for further review
• Create documentation for training peers on new processes
• Monitor metrics and productivity to ensure team is meeting established standards
• Ensure practice management software is setup accurately for all new and existing locations
• Accurately complete assignments in a timely manner
• Adaptable to changing procedures and a growing environment
• Other duties, as assigned

Preferred Qualifications

• At least 2 years of working on coding denials, and understanding of NCCI edits is preferred
• Excel/Google Sheets experienced preferred
• CPC credential is a plus
• Database query or business analyst experience a plus