Revenue Cycle Analyst in Granger, Indiana at Beacon Health System

Reports to the Director or Manager. Responsibilities include process standardization efforts across the revenue cycle departments of the organization through a focus on policies & procedures, education, and training. Develops standard procedures within the Scheduling, Registration, and Verification of Benefits departments within the Revenue Cycle. Works with patient access departments to implement training and process improvement. Prepare, analyze, and provide regular updates for department metrics. Manages and tracks denials from third parties and initiates action for denial resolution, appeal and prevention. Identifies process issues and facilitates resolutions to prevent denials. MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Develops and implements revenue cycle training programs by:

• Document department workflows and develop standard of work processes for patient access departments.
• Providing ongoing technical guidance and assistance to the revenue cycle department associates.
• Work with educators to improve training for new hires and existing associates.
• Ensuring new processes or workflows have a corresponding training plan.
• Evaluating Payer bulletins and newsletters to ensure training materials, workflows and policies are up to date for payer requirements and compliance.
• Communicating payer changes to Revenue Cycle associates and management.

Develops and implements revenue cycle quality assurance programs by:

• Performing quality audits to ensure processes are being followed.
• Work with department managers and educators to review quality audits of associates' productivity.
• Determining additional educational or training needs of associates based on results of quality audits.
• Identifying areas for education opportunities within the patient access departments.
• Working with Department Director using denial data to identify departments and/or individuals for focused quality audits and training.
• Create action plan with department leaders when associates fail to follow standard work processes.

Serves as a liaison and subject matter expert to revenue cycle departments by:

• Outreach to non-revenue cycle departments to implement denial prevention tasks.
• Meeting with revenue cycle departments on a monthly basis to go over errors and denials trends.
• Supports patient access management team by assisting with training, error feedback, and new process implementation.
• Actively participates in Denials meeting by reporting out on open issues.
• Communicating with the Director regarding any concerns.

Revenue Cycle Denial Prevention:

• Initiate action for denial resolution and prevention.
• Analyze and resolve front end problems that affect the claim submission process.
• Involved in other revenue recovery initiatives.

Regulatory Changes and Compliance:

• Review regulatory documentation to ensure current Patient Access departments are compliant with guidelines and to optimize Hospital reimbursement from third parties.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Maintaining up-to-date knowledge about government guidelines and industry standards.
• Developing and maintaining strong working relationships with various departments.
• Working in a positive, proactive, and cooperative manner with other team members, patients, third-party payers and all other customers when providing information, seeking assistance and clarification and resolving issues.
• Completing other job related assignments and special projects as directed.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a post-secondary degree in Business, Finance, Health Information Management, Medical Billing or other related field. Highly preferred; 3 years of experience within revenue cycle with extensive knowledge of revenue cycle operations. Ideally comprehensive knowledge base in one or more functional areas of patient access, HIM, billing, reimbursement, coding, managed care, charge-master/charge capture, or other revenue cycle functions. CHAA or CHAM certification is preferred.

Knowledge & Skills

• Requires fundamental knowledge of the revenue cycle process, which includes such things as utilization review, charge capture, HIM and patient accounting.
• Requires extensive knowledge of front end processes in the revenue cycle.
• Requires advanced proficiency with Microsoft products (Word, Excel-Pivot Tables, Power Point.
• Knowledge of report writing tools preferred.
• Requires high level of analytical, technical, and critical thinking skills necessary to audit patient care data.
• Requires knowledge of rules and regulations pertaining to hospital reimbursement.
• Requires knowledge of Medicare/Medicaid and third-party payer practices and procedures and ICD CM coding, as they apply to revenue cycle processes and automated information systems.
• Requires familiarity with managed care principles and an understanding of post-acute continuum of care.
• Demonstrates the interpersonal and communication skills (both verbal and written) necessary to interact effectively with departments within Beacon, physicians, other Hospital associates and outside organizations (i.e., insurance companies regarding solutions to issues). Also requires the ability to develop and maintain effective working relationships.
• Requires effective communication, presentation, and interpersonal skills (both verbal and written).
• Requires the organization, planning, decision making, problem-solving and math skills necessary to plan and estimate project-related activities and time lines and identify and resolve problems and deliver viable solutions.
• Requires the analytical skills necessary to develop, evaluate, and administer policies and procedures.
• Demonstrates the ability to be self-motivated, detail oriented and make independent decisions. Also demonstrates the ability to respond quickly and appropriately to customer requests.
• Demonstrates a working knowledge of Revenue Cycle applications and reporting tools, including the Hospital's computer systems (e.g., Cerner, Experian and Cobius).

Working Conditions

• Works in a professional office environment.
• May experience some mental/visual fatigue due to the frequent and close work with detail and computers.
• Work may require travel between Beacon facilities.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.