Job Description

Business Analyst - Patient Financial Experience * Days (M-F , 8a-5p) - 40hrs/wk

Requisition #: req12305

Shift: Days

FTE status: 1

On-call: No

Weekends: No

General Purpose of Job:
Under limited
supervision, the Business Analyst plays a critical role in pulling data from
disparate systems, analyzing data and improving process and outcomes. The primary responsibility is to assess
data and develop strategies to enhance operational efficiency and improve
financial performance. This role
supports both Revenue Cycle and Clinical Operations related to revenue
leakage that occurs because workflow isn’t followed, workflow requires
improvements or optimization, or requires with Managed Care Contracting and
insurance companies to challenge policy and procedure for how they are
processing claims. The role requires
working with many different areas, facilitating meetings, and leading small
projects that result in improvement of revenue leakage.
Essential
Duties:
This job description
is intended to cover the minimum essential duties assigned on a regular
basis. Team members may be asked to
perform additional duties as assigned by their leader. Leadership has the right to alter or modify
the duties of the position.
Data Analysis: collect, interpret and analyze revenue cycle
data (billing, coding, operational metrics) to identify trends,
inefficiencies and areas of improvement
Process Improvement: Propose process improvements and
partner with operational areas to implement
Stakeholder collaboration: work closely with
administrative, billing, clinical, IT and operational leaders to improve
revenue leakage
Report findings: escalate issues and status to leadership
Facilitate/lead workgroups, follow up on action
items, present findings, and escalations to leadership
Lead initiatives to reduce write offs with
support from department leadership
Identify denial trends and perform root cause
analysis. Categorizes denials
based upon root cause findings and distributes reports to applicable
management and teams.
Proactively work with multidisciplinary teams
within the organization to develop procedures to reduce the number of
denials received through reporting of denials and education of denial
trends.
Assist with establishing and implementing
denied claims process improvement initiatives and maintains the action
plans to ensure plan objective are being obtained.
Research, develop and maintain a solid
understanding of payer requirements, including filing limit, claim
processing logic, coordination of benefits requirements, patient
responsibility and authorization requirements.
Maintains a strong understanding of payer
contracts and payment methodologies in order to identify their
correlation to denied claims.
Conducts relevant research on best practice
methods to assist with completing the appeals process while staying
informed with policy reforms, new regulations, billing changes, and
accreditation/compliance requirements.
Triages denied claims to identify those that
should be appealed. Responsible
for writing timely, comprehensive and compelling appeals to third party
payers to get denial overturned.Responsible for timely follow up on filed appeals via telephone,
writing or the payer website.
Performs other duties as assigned. These may
include but are not limited to: Maintaining a current knowledge base of
department processes, protocols and procedures, pursuing self-directed
learning and continuing education opportunities, and participating on
committees, task forces, and work groups as determined by management.

Knowledge, Skills and Experience (If something is not
required but is preferred, enter preferred at the end of sentence).

Education:
Bachelor’s degree required

License / Certification / Registration:
5+Years
of experience in billing and/or denials management in hospital
operations with a demonstrated understanding of revenue cycle with an
emphasis on billing, coding, charge capture and reimbursement
methodologies.

Experience:

Skills
& Abilities:
Knowledge of
medical terminology.
Basic knowledge
of CPT’s, HCPCS, and Revenue Codes.
Basic knowledge
of major insurance companies billing policies to ensure compliance.
Advanced
knowledge of payor remittances.
Basic knowledge
of insurance claim forms.
Demonstrates
advanced skills MS Office to include Word and Excel. Working knowledge of PowerPoint.
Experience
analyzing billing data in Epic.
Strong
analytical skills necessary to collect, analyze and interpret denials
data, resolve complex problems.
Ability to
organize, prioritize and manage multiple priority projects
simultaneously.
Highly
motivated, self-starter with attention to detail and accuracy with
excellent written, verbal, and interpersonal skills. Ability to work in a team environment
as well as independently.
Knowledge of
health system regulatory guidelines, standards and experience in
healthcare setting strongly desirable.
Commitment to
team support, participation, and excellence.
Ability to work
with various levels of personnel, demonstrate tact and discretion when
receiving and relaying information.