Job Summary:
The Billing System Configuration Analyst will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes impacting cash collections. In conjunction with IT, they will also oversee system administration for database application, testing, user administration, security access and end-user training, and will be responsible for software maintenance and installation of upgrades.
Job Responsibilities:
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Serves as a source of knowledge for the designated revenue cycle functions.
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Facilitates and manages the full life cycle of the claim process.
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Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.
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Works with IT to oversee system administration for database application, testing, user administration, security access and end-user training.
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Responsible for billing software maintenance and installation of upgrades.
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Responsible for developing appropriate workflows and tracking for the designated revenue cycle function.
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Establishes an ongoing working relationship with other departments impacting revenue cycle performance.
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Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.
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Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
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Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
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By continually reviewing and monitoring billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
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Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.
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Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy.
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Develops, manages and monitors successful completion of implementation and project plans.
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Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.
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Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.
Qualifications:
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At least 3 years of experience in medical billing and Insurance collections
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Strong proficiency in SQL, PowerBI and Excel
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At least 3 years of experience with Prior Authorization requirements, payer utilization management policies and Appeals
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Knowledge of CPT/HCPCS. ICD-10, modifier selection and UB revenue codes
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Bachelor's Degree
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Healthcare related field of study or equivalent experience.
Required Knowledge, Skills and Abilities:
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Proficiency with medical billing systems and the claim life cycle.
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Advanced skills in Microsoft Excel and Google Sheets.
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Proficient knowledge of medical terminology
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Basic knowledge of procedure coding.
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Advanced project management skills.
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Ability to analyze, identify and articulate identified trends and report in a clear and concise manner.
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Intermediate SQL knowledge
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Experience with BI tools, such as Business Objects or Hyperion
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Strong communication (verbal and written), organizational, problem solving and team player skills.
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Ability to navigate across multiple customer demands and balance competing priorities successfully.
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Ability to solve problems using critical thinking skills.
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Maintains confidentiality of sensitive information.
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Analytical skills required.
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Ability to think critically and identify the impact across the revenue cycle with a solution oriented approach.
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Ability to develop, implement and produce analysis and reports
