Revenue Analyst II

Cambridge Health Alliance - Malden, MA

Full-time - Entry Level

Malden, MA

Hospitals

About the position

The Revenue Analyst II plays a crucial role in the financial operations of Cambridge Health Alliance, focusing on hospital charging, billing, and collections procedures. This position is essential for ensuring that the revenue cycle operates smoothly and efficiently, which directly impacts the financial health of the organization. The analyst will be responsible for a variety of tasks, including working on assigned pre-claim edits, resolving rejections and denials through appeals and adjustments, and identifying issues and trends that may affect billing processes. In this role, the Revenue Analyst II will engage with various stakeholders, including payers, patients, and internal departments, to facilitate timely payments and resolve any discrepancies related to charges and billing. This requires a thorough understanding of managed care and payer contractual arrangements, as well as the ability to navigate patient accounting systems to manage account details effectively. The analyst will also maintain provider enrollment records and address claim edits related to enrollment issues, ensuring compliance with all relevant regulations and policies. Candidates for this position should have a minimum of one year of hospital billing experience and proficiency in Epic systems. Ideal candidates will possess experience in hospital billing, claims management, denials, appeal processes, and revenue integrity. The ability to read and interpret Explanation of Benefits (EOB), Remittance Advice, and CMS 1500 data elements is essential. A Certified Professional Coder (CPC) certification is preferred, as it demonstrates a higher level of expertise in coding and billing practices.

Responsibilities

• Perform a variety of tasks associated with hospital charging, billing, and collections procedures.
• Work on assigned pre-claim edits to ensure accuracy before claims are submitted.
• Resolve rejections and denials via appeal and/or adjustment processes.
• Identify issues and trends related to billing needs for processing inpatient and outpatient hospital charges.
• Contact payers, patients, and/or departments as necessary to facilitate timely payments or other required transactions.
• Receive and process correspondence and phone inquiries from internal departments, payers, and other parties regarding charges and/or billing discrepancies.
• Maintain knowledge of managed care and payer contractual arrangements to better comprehend the processing of accounts by third-party payers.
• Navigate patient accounting systems to determine various aspects of account detail necessary for data entry management.
• Maintain provider enrollment records and resolve claim edits related to enrollment issues.

Requirements

• Minimum 1 year of hospital billing experience required.
• Proficient in Epic systems experience required.
• Experience in hospital billing, claims management, denials, and appeal processes is ideal.
• Ability to read and interpret an EOB (Explanation of Benefits), Remittance Advice, and CMS 1500 data elements is necessary.
• CPC certification preferred.

Benefits

• Competitive salaries
• Professional development opportunities
• Comprehensive health benefits
• Supportive work environment
• Commitment to diversity and inclusion