Revenue Cycle Analyst

Sheridan Community Hospital - Sheridan, MI

Full-time

Sheridan, MI

Hospitals

About the position

The Revenue Cycle Analyst position at Sheridan Community Hospital is a full-time role that involves monitoring, researching, organizing, and analyzing data related to the revenue cycle for both the hospital and the Rural Health Clinic (RHC). The analyst will play a crucial role in ensuring compliance with various regulations and laws governing the preparation of cost reports and other submissions. This position requires a high level of efficiency and attention to detail, as the analyst will be responsible for preparing Medicare, Tricare, and Medicaid cost reports, as well as managing annual CRNA reporting and quarterly credit balance reports. In addition to these responsibilities, the Revenue Cycle Analyst will prepare relevant accounts receivable (A/R) reports and departmental census End of Month Reports for management review. The role also involves calculating accurate contractual adjustments for various payers, including Medicare, Medicaid, and Managed Care Payers, and providing explanations for any variances from budgeted levels. The analyst will be responsible for reviewing and calculating appropriate bad debt and charity reserve amounts, as well as managing payer contracts and ensuring accurate setup of all payer contract terms in the relevant systems. The position requires the analyst to stay updated on reimbursement-related regulatory changes and communicate these changes effectively within the organization. The analyst will also be tasked with maintaining the Charge Master, performing market rate setting for procedures, and compiling monthly RVU reports for physician compensation. Additionally, the role involves conducting root cause analysis for billing denials, monitoring key performance indicators (KPIs) for billing and coding, and preparing Payer Scorecards for contract negotiations. The Revenue Cycle Analyst will attend relevant meetings and perform other duties as assigned, contributing to the overall efficiency and effectiveness of the revenue cycle operations.

Responsibilities

• Assist with preparation of Medicare, Tricare, Medicaid cost reports and related reimbursement studies.
• Responsible for annual CRNA reporting.
• Responsible for Medicare/Medicaid quarterly credit balance reports.
• Ensure compliance with all provider regulations and laws governing the preparation of cost reports and other submissions.
• Prepare relevant A/R, departmental census End of Month Reports for Management review.
• Prepare monthly calculations to ensure accurate contractual adjustments for Medicare, Medicaid, Managed Care Payers, and any other payers.
• Provide reasonable explanation of reimbursement contractuals/deductions as well as net revenue variance from budgeted levels on a monthly basis.
• Review and/or calculate appropriate bad debt/charity reserve amount (allowance for bad debt).
• Manage Payer Contract Management and work closely with 3rd Party Payer Contracting.
• Review reimbursement related payer regulatory changes and assist Senior Management in understanding and evaluating the impact of these changes.
• Communicate reimbursement related information to appropriate individuals throughout the organization.
• Review, update and implement the annual and daily Charge Master maintenance - price increase/adjustment.
• Perform periodic market rate setting for various procedures, Revenue Codes, CPT/HCPCS and work RVUs.
• Compile monthly RVU reports for physician compensation.
• Perform root causes analysis and offer recommendations for improvement opportunities to ensure accurate billing information is captured in the billing system.
• Develop and maintain denial reports from eCW, Thrive, and TruBridge RCM for root cause analysis.
• Identify the source of denials and prepare, analyze and distribute monthly third party denials reports regarding trends in denials.
• Monitor KPIs standards for billing and coding.
• Prepare Payer Scorecards to share with Managed Care Contract partners for use during contract renegotiations.
• Attend Revenue Cycle and 3rd Party Payer Contract meetings as required.
• Perform other duties as assigned (i.e. adhoc reporting).

Requirements

• Bachelor's degree in Finance, Business Administration, Healthcare Administration, or equivalent work-related experience.
• Minimum of 5 years of relevant experience.
• Proficient in all Microsoft Office applications as well as medical office software.
• Proven experience in healthcare billing.
• Sound knowledge of health insurance providers.
• Strong interpersonal and organizational skills.
• Strong analytic skills and detail-oriented.
• Excellent customer service skills.
• Ability to work in a fast-paced environment.