FLSA Status

Exempt

Job Role Summary

The Provider Relations Analyst is responsible for maintaining a high degree of understanding of the provider enrollment structure, billing requirements and clinical workflows. This position utilizes complex analytical skills and attention to fine details in data to identify deficiencies in enrollments that impact revenue capture for services rendered by enrolled providers. The position meets one on one with members of the enrollment department, billing, clinical leadership and senior leadership individually or in meetings as required to ensure a complete understanding of issues in order to ensure quality data, accuracy in analysis and support of problem-solving and decision-making processes.

Essential Functions and Responsibilities

• Compiles and analyzes reports, using effective data management principles from various data sources including EPIC and FinThrive Claims Data, Payor Rosters from contracted payors, CACTUS (Symplr) Provider Enrollment Database, CAQH and other sources to identify gaps impacting revenue capture.
• Utilizes and applies effective data management principles to ensure that reports and analysis are highly reliable demonstrating a high degree of accuracy, data quality (free from errors and omissions), consistent, secure (limiting edit access only to designated individuals), accessible (easily interpreted and understood and usable by recipients), and maintained in an orderly manner to ensure ease of retrieval to support future decisions and reference including appeals to payors, and internal decision makers.
• Works independently and with multi-disciplinary teams including both internal and external partners at all levels of the organization including finance, billing, revenue integrity, provider enrollment, claims, clinical and senior leadership to discuss and apply analytical findings through verbal, written and visual display of findings in a well organized easy to follow manner that can be easily replicated and understood by others.
• Maintains an in depth understanding of relevant data sources to ensure an objective, data driven analysis and approach to solving complex problems.
• Maintains a high degree of knowledge of Federal and State laws and regulations, payor and contract requirements pertinent to billing, provider enrollment, credentialing and related areas.
• Access payor systems and portals to obtain relevant information including provider enrollment status, location enrollment status and related topics (includes but not limited to PECOS, Indiana Medicaid Portal, and all contracted payor sites).
• Creates and maintains a high degree of organization to maintain all reports, analysis, and decision- making tools and resources to ensure that they are easily accessible by others based upon needs of the project and departmental needs and policies.
• Supports the Provider Relations, Delegated Credentialing, Enrollment and Claims Administration functions through data analysis, development of executive summaries and specific action steps needed to resolve identified problems.
• Works collaboratively with other members of the department to ensure timely follow-up on identified issues including tracking escalations and supporting follow-up through contacts with operations, finance, leadership, payors and others as needed to ensure timely resolution of identified problems.
  

Job Requirements

• Bachelor’s in Health Information, Finance or related field with 2 years analytical experience
• In Lieu of degree – Must have 5+ years experience in healthcare, project management or business in a role that focused on analytics preferably in healthcare
• Lead or Supervisory experience preferred
• Experience in developing reports and analytical summaries highly preferred
• Lean Sigma Green/Black Belt strongly preferred

Knowledge, Skills & Abilities

Knowledge of:

• Healthcare reimbursement and operations
• Healthcare Revenue Cycle
• Hospital Information Systems
• Medicare and Medicaid regulations impacting healthcare reimbursement and operations

Skills:

• Gathering and analyzing data including provider, claims and financial data
• High proficiency and solid background/experience using tools such as formulas, VLOOKUP and other EXCEL tools and functions
• Knowledge of MS Office Suite
• Strong analytical skills especially in the healthcare environment with demonstrated ability to manage multiple data sets simultaneously

Ability to:

• Exercise independent judgement and decision making
• Independently research relevant primary sources (CMS, Medicaid, CAQH, NCQH, and Payor Guidance)
• Work well under pressure in a fast-paced environment
• Function independently and demonstrate a strong sense of urgency and ownership of responsibilities
• Demonstrate effective time management skills
• Work well under pressure with deadlines for multiple simultaneous projects
• Communicate effectively with multi-disciplinary teams, including operational and clinical leaders at all levels (verbal, written)
• Demonstrate professionalism when conveying ideas and presentation of reports
• Navigate discussions and interactions involving complex issues looking objectively at all sides and for alternative ideas and solutions
• Establish a strong working relationship with key stakeholders across various departments with Eskenazi, Eskenazi Health Centers, SEMHC, and EMG as well as externally (payors, vendors, providers)
• Comply with all policies and procedures, laws, and regulations