Team Lead Revenue Cycle Analyst

Vidant Health - Greenville, NC

Full-time

Hybrid - Greenville, NC

Hospitals

About the position

The Revenue Cycle Analyst Team Lead will act as a lead in developing, maintaining and generating all data analytics pertaining to revenue cycle activities and key performance indicators (KPIs). This position will work closely with subject matter experts in their assigned area to support day to day business functions, performance improvement initiatives, reconciliation, benchmarking and reporting. The Team Lead is responsible for leading and assisting in projects to enhance all aspects of revenue cycle operations. Responsible for the development, assessment and quantification of trends.

Responsibilities

• Assist in developing dashboards and reports with key performance indicators and metrics to support achieving optimal revenue cycle results.
• Assist revenue cycle managers and staff in developing strategies to improve revenue cycle statistics, reporting capabilities, and overall revenue performance.
• Serve as resource for special projects and priority assignments as needs are identified during the analysis process.
• Assist in the initiation, conducting and coordinating of studies and analysis on resource allocation, financial program evaluation reviews.
• Develop and maintain working relationships with Revenue Cycle departments, and external contacts as appropriate.
• Formally present data and information to the management to analysis.
• Assist and provide back-up coverage for the Analysts.
• Assist in maintaining data for internal Revenue Cycle analysis and be able to translate these activities into general terms for non-technical audiences and senior management.
• Lead communications with vendors and internal customers to create data extract files.
• Engages in decision making support by providing analysis of data based on user inquiries.
• Assist in tracking and analyzing data to identify, recommend, and implement opportunities to secure revenue for the organization.
• Analyzes and reviews third-party payer medical claims and work with the denial departments to develops and executes strategies to decrease denials system-wide.
• Identifies trends or patterns that impact payment optimization, and collaborates with departments to establish action plans, initiatives, and policies to reverse negative patterns.
• Analyzes trends and inefficiencies in charges and recommends suitable operational improvements in an effort to prevent incorrect payments and denials.
• Complete monthly standard reports: Parse and share trends and data to operational areas for review on a monthly basis; attend needed follow-up calls for support in operational reviews amongst owning areas.
• Identify and communicate system issues stemming from billing, edits, rejections, and follow-up work queues with Director and Billing management.
• Independently facilitates discovery and design sessions for new complex build activities including new automation use cases or enhancements to existing functionality using best practices for automation design and development.
• Assists in the creation of automation design documents to support business decision-making, process streamlining, automation development, and performance improvement to meet business needs.
• Support in the submission of complex case reviews and appealing surrounding high-priority denials such as auth, medical necessity, COB, etc.
• Coordinate with revenue cycle management to develop, generate, and audit various revenue, financial, statistical, and/or quality reports surrounding the denial prevention area of focus.
• Support the development, implementation, and evaluation of existing policies and procedures.
• Submit optimization tickets to resolve issues, support in testing and training as necessary.
• Support Rev Cycle management in the preparation of data and strategic opportunities for executive-level audience.
• While Working with the Application Analysts, will thoroughly test and document system upgrades and software modifications.
• Work as a liaison with IS&T and third-party vendors to apply system functionality and upgrades, as well as testing and validation.
• Provide ongoing training.
• Serves as an active team member; participates in department and company-wide initiatives; contributes to the overall culture.
• Maintains tracking documents and dashboards.
• Conduct special projects as needed.
• Perform other related duties as required.

Requirements

• Bachelor's degree or higher in accounting, Finance, Mathematics, Data Science, Statistics or 5+ years of related work experience can be substituted for degree.
• 3+ years in leadership role related Revenue Cycle financial reporting in a multi-facility/practice healthcare system.
• 2+ years of demonstrated professional experience in an Analyst role.
• 3+ years of experience in an Acute Care Hospital / Physician Health System Revenue Cycle, Accounting, Finance, Information Technology or Decision Support role.
• Epic Resolute certification.

Nice-to-haves

• Master's Degree and/or 8+ years related work experience.
• Epic PB/HB Resolute, Cadence and Prelude certification.
• Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare and North Carolina Medicaid reimbursement methodologies.
• Knowledge of third-party payer reimbursement methodologies and contracts.
• Knowledge of CPT, HCPCs and ICD-10 coding principles.
• Proficiency with Revenue Cycle data applications.