Revenue Cycle Analyst

Hackensack Meridian Health - Edison, NJ

Full-time - Mid Level

Edison, NJ

Hospitals

About the position

The Revenue Cycle Analyst at Hackensack Meridian Health plays a crucial role in monitoring and analyzing accounts receivable activities. This position is responsible for providing statistical and financial data to management, identifying issues related to denials and payment variances, and supporting the Revenue Cycle team in improving cash flow and revenue management. The analyst will collaborate with various departments to ensure compliance with billing regulations and enhance operational efficiency.

Responsibilities

• Participates & Reports on Weekly Graph & Workflow meetings on Denials trending for the Network.
• Identifies and performs root cause analysis of high volume denials, and presents the findings to the Revenue Cycle team.
• Communicates improvement opportunities and corrective actions based on findings.
• Acts as Team Leader to ensure all team members are trained & aligned with established Desktop & policies & procedures.
• Performs analytical review of denials to support Revenue Operations, Case Management, Access, and other departments as it relates to denials and payment variances.
• Determines the reasons for denials, meets with appropriate Revenue Cycle leaders, and makes recommendations to prevent future denials and payment variances.
• Identifies problems in process flow or changes in payer's billing rules and regulations and governmental guidelines that slows cash flow and workflow and disseminates information to management.
• Collaborates with the Training department on developing education materials based from the resolutions/outcomes of the improvement opportunities presented at inter disciplinary meetings.
• Collaborates with Reconciliation Manager in developing processes and workflows on trends identified on various areas of operation.
• Performs accounts receivable and financial review for the Revenue department.
• Communicates revenue impact to the department and helps identify and recommend improvement opportunities.
• Prepares trending reports of all high volume denials and payment variances.
• Meets biweekly and monthly with various departments to communicate findings and recommendations to improve revenue management.
• Works closely with front-end (Access) regarding up-front cash collection, registration, and eligibility denials.
• Schedules biweekly meetings to resolve issues that will slow cash collection.
• Acts as Subject Matter Expert (SME) for complex denials and payment variances including contracts, fee schedules, and edits.
• Educates and provides feedback to various areas on Revenue Cycle metrics and key performance indicators.
• Utilizes and develops new Epic and ad-hoc accounts receivable or denial reporting tools for management.
• Tracks and reports on causes of manual adjustments which will be the basis of escalation to Information Technology for contract management corrections.
• Performs staff audits based on manual adjustment reports.
• Reviews activities to improve the revenue cycle.
• Ensures that the team is following departmental procedures and are in compliance with governmental and commercial payer guidelines.
• Performs reimbursement management, analyzes payer reimbursement to ensure proper claim adjudication, and tracks and reports on high volume payment discrepancies.
• Monitors payments denials and initiates CPT or DRG analysis to determine reasons for denial.
• Monitors daily dashboard and reports and conducts analytical reviews to determine if changes or enhancements on current policies and procedures are required.
• Participates, schedules, and coordinates meetings with appropriate personnel to exchange ideas on working towards accounts receivable related changes or enhancement.
• Conducts accounts receivable audits as defined by SVP, Sr Revenue Officer and Revenue Operations Managers.
• Analyzes manual adjustment reports monthly to evaluate appropriateness, and report findings to the SVP, Sr Revenue Officer.
• Calculates target/actual cash collection on a timely basis for management review and analyzes wide variations in the expected outcome.
• Meets biweekly and monthly with various vendors and outside agencies to discuss bottlenecks in revenue flow and discusses solutions.
• Acts as a liaison between agencies and Reconciliation department to prevent AR aging and timely flow of communication.
• Monitors account work queues, analyzes trends, and follows up if metrics exceed or fall below baselines.
• Assists with ongoing management of Epic as it relates to Resolute Hospital Billing Nova Notes and other Epic enhancements.
• Able to perform all Adjustment Representative functions/tasks and other duties as assigned.

Requirements

• Bachelor's degree or equivalent work experience.
• Minimum of 4 years of related work experience.
• Strong analytical, mathematical, and report writing skills.
• Knowledge of computers or hospital billing systems.
• Proficient in Microsoft Office or Google applications.
• Excellent communication and interpersonal skills.
• Thorough knowledge of billing requirements and regulations of major payers.

Nice-to-haves

• Experience in healthcare.
• Knowledge of Managed Care contracts, Medicare, and Medicaid.
• Proficient in SMS, Epic and/or other hospital billing systems.
• Knowledge of ICD-9/10 and medical terminology.

Benefits

• Competitive salary
• Comprehensive health insurance
• Retirement savings plan
• Paid time off
• Professional development opportunities