Payer Relations Analyst II - Manning - Finance

Shift: Monday - Friday
Pay Range: $30.50 - $44.17 Depending on Years of Experience


JOB PURPOSE: The Payer Relations Analyst II is responsible for performing financial analysis of varying complexities to include but limited to revenue cycle system, modeling of contract performance to include value based and maintain fee schedules that drive expected allowable. This role works closely with the Business Office and it varied operations while supporting the Controller by compiling and analyzing Accounts receivable and Revenue trends. This position is instrumental in facilitating system and process fixes to ensure expedited submission of clean clams and improving revenue capture from data-driven points.

An employee in this position works with general supervision and reviews any work problems involving departures from standard policies, interpretations, or procedures that are presented to the supervisor for resolution.

Essential Job Functions:

◦ Proactively search for systems and data anomalies to identify issues and opportunities for manual and system corrections.
◦ Input and maintain contracts and benefit plans in the system.
◦ Test contracts and benefits plans to ensure output as expected. Create and maintain data for internal and external Revenue cycle analysis and modeling and explain and translate findings into general terms for non-technical audiences
◦ Documents business processes/procedures and makes recommendations for workflow improvements and optimization.
◦ Serves as administrator for claims vendor and other related operational applications. Responsible for the on-going maintenance, testing, development of workflows, workflow analysis, change documentation, application support, monitoring and optimization of EPIC maintained systems.
◦ Participates in and/or leads the implementation or enhancements of systems, software, and solutions to system related problems, specific to Revenue Cycle.
◦ Evaluates Revenue Cycle needs and facilitates the development of configurations that support business processes.
◦ Promotes and actively seeks to develop positive internal (team members) and external (El Rio customers) relations. Collaborates across multiple organizational areas.
◦ Performs application validation as part of El Rio’s full Revenue Cycle testing policies Identify and summarize basic characteristics in data and trends in data patterns related to Revenue Cycle, including, but not limited to, encounters, utilization, denials, payment by payer and undistributed payments.
◦ Presents information using data visualization techniques
◦ Meets established time frames and rates of performance for the quality and quantity of work for the position
◦ Analyzes EDI and data requirements from customers and insurance carriers, to ensure clean claim submissions and works to resolve any barriers by working with IT PB EPIC partners to correct claims formatting issues.
◦ Acts as a resource to support staff. Interacts with all employee levels on billing/EDI issues.
◦ Works closely and cooperatively with IT development/support team on product design; makes recommendations for changes to enhance support and usability
◦ Gains and maintains a general understanding of applicable Federal, State, and commercial payer requirements, standards, regulations, or laws; as well as all organizational policies and procedures related to healthcare benefits payment and processing.
◦ Assists department leadership by performing and completing assigned processing that supports file maintenance within the Practice Management and Electronic Health Records systems.
◦ Identifies processing anomalies observed and report these situations or observations to the assigned supervisor in a timely manner.
◦ Performs administrative or fiscal duties, tasks, and assignments supporting business office operations within established timeframes; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence.
◦ Assists with creating end-user training and documentation.
◦ Maintains at all times patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted confidentiality standards.
◦ Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
◦ Demonstrates an unders