VHBH Revenue Cycle Analyst II

Vail Health has become the world’s most advanced mountain healthcare system. Vail Health consists of an updated 520,000-square-foot, 56-bed hospital.  This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail. Learn more about Vail Health here.

About the opportunity: The Revenue Operations Analyst oversees the revenue cycle operations for Vail Health Behavioral Health to ensure accurate and complete charge capture, coding, denials management, and financial and clinical chart auditing to optimize revenue capture for the service line. Position works in collaboration with VHBH leadership and the Vail Health Revenue Integrity department. This position is instrumental in providing compliance and decision-making support to all levels of the Vail Health Behavioral Health team as it relates to clinical revenue and clinical chart audit management and initiatives.     What you will do:

1. Oversees the evaluation of current charging, coding, and auditing processes in Vail Health specialty clinical areas and makes recommendations to ensure optimal and accurate charge capture.
2. Provides education, feedback, and documentation to Vail Health specialty clinical areas and leadership on identified issues to support correct charging and coding at the point of charge entry. Provides guidance and education to Vail Health specialty departments on updated charging and coding practices.
3. In alignment with the Revenue Integrity department, identifies required changes to the charge description master (CDM) by understanding the federal, state, and third-party charging guidelines, assists the revenue integrity department with CDM tasks related to Vail Health Specialty clinics including charge reconciliation, clinical charge entry education, yearly Current Procedural Terminology (CPT) updates.
4. Assists departments in researching and resolving issues, edits, charging/billing errors or denials related to the charge master in accordance with regulatory guidelines.
5. Identifies opportunities for capturing additional revenue in accordance with payor guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits / rejections.
6. Prepares reports on non-compliance or error trends and works with the departments to facilitate compliance, ensure appropriate revenue capture, and/or reduce Accounts Receivable (AR) through efficient process flow.
7. Prepares production, openfill, backfill, no show, and other patient trend reports to ensure efficacy in patient access and availability.
8. Reviews current pricing as compared to Ambulatory Payment Classification (APC), Physician Fee Schedule (PFS) and market data. Provides back-up support to Patient Financial Services to provide procedure cost estimates in response to patient inquiries.
9. Quantifies and provides comparative data to understand the impact of how changes to the charges will financially impact the department or facility.
10. Provides CDM/charge-related data/reports for decision-making support, as requested and within scope.
11. Builds strong relationships and facilitates effective communication between hospital and clinic operations and core support departments such as Patient Access, Revenue Cycle, IT, HIM, and Compliance.
12. Role models the principles of a Just Culture and Organizational Values.
13. Perform other duties as assigned. Must be HIPAA compliant.

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.   What you will need:   Experience:

• Three years of related revenue cycle experience, required.
• CDM experience in an acute care organization, required.
• ICD/DRG and/or CPT/APC coding and reimbursement concepts knowledge, required.
• Facility and/or professional coding and billing knowledge, required.
• Knowledge of patient billing systems, health procedures and classification systems, required.
• Knowledge of hospital accounting systems and practices as related to patient billing, required.
• Proficiency in medical terminology, hospital charge masters, charge review, clinical record information systems, and coding methodologies, required.
• One year of specialty clinic experience, preferred.
• Experience in implementing patient billing and accounting systems, preferred.
• Experience with Cerner, preferred.

License(s):

• N/A

Certification(s):

• One