Analyst-Quality Assurance - Revenue Cycle-Rev Enhancement

Baptist Memorial Health Care - Memphis, TN

Full-time - Entry Level

Memphis, TN

Hospitals

About the position

The Analyst-Quality Assurance position at Baptist Memorial Health focuses on evaluating the adequacy and effectiveness of internal and operational controls within the revenue cycle. This role is essential for ensuring that processes lead to appropriate adjudication of claims, requiring a thorough understanding of regulatory requirements, managed care contracts, and revenue integrity.

Responsibilities

• Conduct audits to determine organizational integrity of revenue cycle activities impacting claims adjustment processing.
• Perform risk assessments to define audit priorities based on previous findings and current adjustment volumes.
• Complete special accounts receivable projects to address aging accounts.
• Review timely filing adjustments to ensure all appeal attempts have been made.
• Communicate audit results to service departments and leadership, providing recommendations for corrective actions.
• Serve as a subject matter expert on contract language interpretation for appropriate insurance reimbursement.
• Conduct independent audits of revenue integrity and business office activities, both scheduled and unscheduled.
• Perform retrospective and prospective account audits as directed by the revenue cycle director.
• Assess communication of changes to enhance interdepartmental communication.
• Adhere to audit timelines and protocols, assisting in the development of the audit schedule.
• Identify self-development needs and implement a professional growth plan.
• Apply standardized compliance audit methodology for sample selection and reporting of findings.
• Prepare written reports of audit findings and recommendations, presenting them to business offices and evaluating management's corrective actions.
• Participate in the development of departmental goals, objectives, policies, and procedures.

Requirements

• High school diploma or GED required.
• Minimum of 2 years of experience in the healthcare industry with knowledge of revenue cycle functions.
• Associates Degree related to healthcare or information technology preferred.
• Understanding of industry-specific terminology and managed care policy manuals.

Nice-to-haves

• Detailed knowledge of revenue cycle work streams and revenue flow.
• Moderate systems expertise and experience with facility and professional billing requirements.

Benefits

• Competitive salaries
• Paid vacation/time off
• Continuing education opportunities
• Generous retirement plan
• Health insurance, including dental and vision
• Sick leave
• Service awards
• Free parking
• Short-term disability
• Life insurance
• Health care and dependent care spending accounts
• Education assistance/continuing education
• Employee referral program