Revenue Cycle Reporting Analyst

Overview

The Revenue Cycle Reporting Analyst (“RCA”) will work under the general supervision of the Director, Business and Clinic Operations. This position is responsible for ensuring that patient billing and processing of payment receipts are completed in a timely manner and in accordance with policy. The RCA will minimize bad debt, improve cash flow and effectively manage accounts receivable. This position will coordinate effective support to management for all revenue cycle activities across the organization to include, but not limited to front desk, out-patient billing, hospital billings, collections, staff and physician training.

Responsibilities

• Participate in program/service evaluation activities that include facilitation and changes in provision of service based on Continuous Quality Improvement results (i.e. Denial Management, MIPS, HEDIS, etc.).
• Compile and prepare various status reports for management in order to analyze trends.
• Participate in preparation of monthly, quarterly and annual financial reports with TUMG Corporate Leadership.
• Monitor data integrity of the practice management system to include reconciliation of charges and collections. Report problems to their Supervisor, or other appropriate personnel, as directed in a timely manner.
• Provide a weekly summary on the status of outstanding charges greater than 90 days in the Accounts Receivable Aging report.
• Provide report on the status of credit balances. (Unapplied Credit Analysis Report)
• Monitor gross charges to determine the potential need for an update to the fee schedule on at least an annual basis. Report findings and recommendations to TUMG Corporate Leadership.
• Facilitate and ensure the RVU Schedule and Fee Schedule is updated in the EMR annually and calculated accurately based on the annual CMS Update for the Practice location.
• Monitor volume of Open Encounters, on a weekly basis to confirm that all encounters for out-patient and hospital are being entered in a timely fashion.
• Communication with all healthcare providers on a weekly basis regarding open encounters.
• Responsible for ensuring the timeliness of processing and correction of Claim Edit and Rejection Reports from the EMR and Clearinghouse, as well as rejected claims (i.e.: Denial Management).
• Monitor coding practices among providers to determine potential patterns of under coding or other irregularities through pre-claim chart scrubbing in-house or with the third-party billing agency, and NCCI Edit outcomes.
• Maintain current information for billing and collections processes for each third-party carrier in a Billing Manual.
• Monitor and identify any patterns in remittance advices which would indicate employees are not properly collecting insurance information (i.e.: Denial Management).  In coordination with the Supervisor, initiate retraining and/or other corrective action as indicated.
• Address any deficiencies in healthcare providers and staff performance uncovered by internal audits and monitoring with the RCA’s Supervisor.
• Must hold all patient Protected Health Information (PHI) and other patient personal information and agency information in confidence and in accordance with the Employee Confidentiality Statement, which you have read, understand and signed.
• Actively participates in and complies with all aspects of the Corporate Compliance Program, follow the Program Code of Conduct and obey all relevant laws, statutes, regulations and requirements applicable to Medicaid, Medicare and other State and Federal health care programs.
• Participate in CQI, other internal committees, special projects/observances or activities that promote improvements in organizational performance and/or advance the mission, goals and objectives of Touro University Medical Group.
• Adhere to schedules for work, lunch and breaks.
• Perform any other duties as assigned.

Supervisory Responsibilities:

Indirect supervision of Clinic Billing Staff

Qualifications

• Functions with minimal direct supervision.
• Must have at least 2-4 years of progressive experience in medical billing.
• Bachelor’s degree in Finances preferred or equivalent experience.
• Must be dependable and conduct him/herself in a professional manner.
• Demonstrates skill in use of personal computers, various programs and applications required to competently execute job duties.
• Possesses knowledge of quality management processes.
• Demonstrates ability to establish and maintain effective internal and external working relationships.
• Must demonstrate the ability to exercise sound judgment and discretion.
• Must be an effective communicator with strong oral, written and presentat