Senior Analyst-Contract Compliance/Revenue Integrity Lead

Bryan Health - Lincoln, NE

Full-time - Mid Level

Lincoln, NE

Hospitals

About the position

The Senior Analyst-Contract Compliance/Revenue Integrity Lead at Bryan Health plays a crucial role in ensuring that payer contracts are adhered to and that revenue realization is maximized. This position involves providing in-depth analysis and expertise in compliant reimbursement to assess the performance of contracts for facilities and providers. The analyst will support the development and implementation of initiatives aimed at enhancing contract compliance analysis, which is essential for achieving financial goals. The role requires collaboration with the Managed Care department to recommend revisions to underperforming contracts, ensuring that all aspects of contract compliance are monitored and enforced effectively. In this position, the analyst will act as a subject-matter expert, assisting the Revenue Integrity team with various tasks, including charge master setup, auditing charging practices, and understanding payer policies. The analyst will also lead efforts to address denials, ensuring that all options are explored before writing off any denial. This includes setting up teams to work with operations to identify and rectify the root causes of denials, thereby promoting denial avoidance strategies. The Senior Analyst will prepare complex financial reimbursement analyses and models, identifying discrepancies and trends that inform contract compliance efforts. They will present findings to leadership and other stakeholders, facilitating strategic planning activities related to contract compliance. Additionally, the analyst will maintain knowledge of industry trends and regulatory requirements, ensuring that the Revenue Integrity team remains compliant with all relevant guidelines. This role is integral to promoting effective communication between various departments, including Revenue Cycle, Managed Care, and Finance, to expedite problem resolution and enhance revenue realization.

Responsibilities

• Commits to the mission, vision, beliefs and consistently demonstrates core values.
• Plans and directs the analysis and collection of payment variances.
• Identifies, collects, and manipulates data within multiple contract modeling tools, billing systems and databases to assess contract performance opportunities.
• Assesses various reimbursement structure options and develops models, reports and tactics to ensure compliance with contracted reimbursement structures.
• Prepares reimbursement analyses and financial performance analyses, performing complex financial reimbursement analysis to identify root-cause discrepancies and trends.
• Prepares and effectively presents results to Revenue Cycle, Managed Care and Finance leadership for review and strategic planning activities.
• Acts as the subject matter expert to support the Revenue Integrity Liaisons in setting up CDMs and maintaining accurate charging practices.
• Leads and assists the Denials Insurance Specialists through the accurate processing and appeal process for denials.
• Leads and assists the Revenue Integrity team through regulatory compliance review, auditing, and implementation involving charging and billing practices.
• Maintains knowledge of industry trends, payer policies and protocols, and revenue cycle operations to support effective contract compliance activities.
• Prepares routine reports and ad-hoc analyses as required, accurately reflecting actual vs. expected contract performance trends.
• Leverages reporting and effectively communicates issues to internal department leads and managed care payers for resolution.
• Becomes certified as an Epic Contract Builder and assists with building and maintaining contracts.
• Provides a critical liaison and advocate to identify and rectify contract compliance issues with managed care payers.
• Acts as the point for all Contract Compliance issues.
• Promotes effective communications between Revenue Cycle, Managed Care, Finance and Payer personnel to ensure consistency and expedite problem resolution.
• Maintains professional growth and development through seminars, workshops, and professional affiliations.
• Participates in meetings, committees and department projects as assigned.

Requirements

• Knowledge of financial healthcare reimbursement analysis, including an understanding of diagnosis and procedure coding, billing practices, and payment methodologies.
• Knowledge of computer hardware equipment and software applications relevant to work functions.
• Knowledge of third party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs.
• Knowledge of CMS and payer regulatory requirements as it pertains to hospital and professional charging and billing practices.
• Understanding of and working knowledge of hospital charge master and department charging practices.
• Understanding of and ability to resolve denials through review of payer policy and contracts with system updates or effective appeal processes.
• Skill in conflict diffusion and resolution along with the ability to perform crucial conversations with payers or internal leaders with desired outcomes.
• Ability to problem solve and engage independent critical thinking skills.
• Ability to understand and translate operational knowledge to identify unusual payer circumstances, trends or activity.
• Ability to evaluate and enforce negotiated contract rates and terms in collaboration with revenue cycle partners.
• Ability to lead, coordinate and organize tasks and projects through various complex and challenging situations to completion under time-sensitive deadlines.
• Ability to maintain attention to detail and concentration for long periods of time.
• Ability to synthesize, coordinate, and analyze data, find opportunities to automate many simple and repetitive tasks.
• Ability to maintain a work pace appropriate to given workload, to perform complex and varied tasks and to understand and remember detailed instructions.
• Ability to make independent decisions and/or exercise judgment based on appropriate information.
• Ability to recommend operational and management decisions in response to changing conditions.
• Ability to communicate effectively both verbally and in writing.
• Ability to establish and maintain effective working relationships with all levels of personnel.
• Ability to maintain confidentiality relevant to sensitive information.
• Ability to maintain regular and punctual attendance.