Revenue Cycle Business Analyst

Mass General Brigham - Somerville, MA

Full-time - Mid Level

Remote - Somerville, MA

1,001-5,000 employees

Ambulatory Health Care Services

About the position

The Revenue Cycle Business Analyst plays a crucial role in overseeing outsourced debit and credit accounts receivable, payment posting, and related Patient Financial Services (PFS) tasks and projects. Reporting to the Senior Manager, this position is integral to ensuring high-quality service delivery by monitoring, triaging, and reporting issues related to vendor management. The analyst will work closely with various teams, including vendor management, CPBO, DHeC, and MGB, to identify workflow and operational deficiencies, track accounts receivable (AR) and denial trends, and implement resolutions to enhance vendor experiences. In this role, the analyst will lead investigations into workflow issues, maintain tracking logs for denial trends, and escalate issues based on risk factors. Continuous improvement is a key focus, as the analyst will monitor Service Level Agreement metrics and proactively identify opportunities for enhancement. The position also involves coordinating vendor staff onboarding, resolving inquiries from management regarding vendor workflows, and leading quality assurance audits related to workflow routing logic. The Revenue Cycle Business Analyst is expected to maintain constructive relationships with internal departments and external vendors, representing the MGB RCO effectively. The role requires a solid understanding of revenue cycle management, including patient intake, medical coding, and billing processes, while adhering to HIPAA guidelines. The analyst will also be responsible for developing, documenting, and monitoring policies and procedures to ensure effective utilization by vendors, ultimately contributing to the institutional goal of increasing revenue and decreasing denials.

Responsibilities

• Oversee outsourced debit and credit accounts receivable and payment posting.
• Monitor, triage, and report issues related to vendor management.
• Drive issue identification and resolution by working with tracking logs.
• Maintain, triage, and report denial trends/issues identified by vendors and internal staff.
• Escalate issues based on experience and risk factors.
• Review work queues to validate/identify denial issues.
• Drive continuous improvement within outsource performance by monitoring Service Level Agreement metrics.
• Proactively identify opportunities, challenges, and trends by monitoring key performance indicators.
• Lead engagement discussions with internal management resources for guidance and recommendations.
• Coordinate vendor staff onboarding tasks and requests.
• Resolve inquiries from MGB RCO Management team related to vendor workflow protocols.
• Lead quality assurance validation audits related to new/revised workflow routing logic.
• Establish and maintain new business checklists for onboarding success.
• Analyze and recommend corrections for operational challenges and breakdowns.
• Assess needs and implement policy and process improvements.
• Lead project-related meetings, including agenda creation and material preparation.
• Develop and maintain working relationships across Revenue Cycle, Operations, and DHeC.

Requirements

• Bachelor's degree or equivalent experience required.
• Minimum of 5 years of revenue cycle management or healthcare analytical experience.
• Demonstrated expertise working with Epic system required.
• Experience with professional and/or hospital billing and/or academic medical center preferred.
• Prior management level experience preferred.
• Exceptional organizational skills and flexibility to manage multiple tasks in a fast-paced environment.
• Ability to juggle multiple projects/priorities to meet department goals and deliverables.
• Task-oriented individual with a drive to complete and take responsibility for various projects.
• Ability to effectively conduct meetings, both formal and informal.
• Ability to work independently and within a team environment.
• Demonstrated ability to problem solve and function as a resource to resolve complex issues.
• Proficiency with business software, including Microsoft Office Suite; SharePoint experience a plus; knowledge of HIPAA policies is desirable.

Nice-to-haves

• Knowledge of healthcare billing and Epic required.
• Well versed in payer billing rules and requirements.
• Experience in a hospital or academic medical center environment.