Overview

Halifax Health is seeking a Business Analyst II: Revenue Cycle - Payer Contracts for the Patient Business and Financial Services (PBFS) Department.

Summary

The Business Analyst II: Revenue Cycle – Payer Contracts will perform various functions to support the build, validation, and ongoing evolution of payer contracts for Halifax Health. This role will work closely with the IT and managed care departments as part of and post EPIC implementation to design, develop and validate the accuracy of payer contracts loaded to produce anticipated results. This role will hold a technical and operational relationship between departments to review with a focus on interpreting and implementing reimbursement terms in a collaborative setting. This role will support stakeholders with the necessary analysis of data, modeling and provide other reporting necessary for contract negotiations as well as support in the interpretation of contract language to support operations.

Job Qualifications

• Require master’s degree or higher in below field (will substitute education requirement to bachelor’s degree with applicable experience)
  •  Healthcare administration, business administration, finance, computer science or healthcare related field. Equivalent experience in related role will be accepted to supplement educational requirement

• Seven years’ experience in managed care contract processing or related experience required

• Experience in at least one Epic module: Prelude, Cadence or Grand Central (preferred, not required)

• Certification in applicable Epic module (preferred, not required)

• Experience with EPIC payer contract processes preferred

• Requires skills in the following areas:

  • Strong interpersonal skills

  • Customer service

  • Problem-solving

  • Innovative thinking

  • Analytical skills

  • Microsoft Office Applications

  • Requirements gathering and documentation

• Experience

  • Minimum seven years’ experience in managed care, Patient Financial Services, pricing and/or provider payment methodology workflows in acute or outpatient setting

  • Experience interacting with ICD-10, CPT and HCPC codes and the relationships they hold to claim processing

  • Exposure or experience in revenue cycle processing from the point of intake through the point of a resolved account balance

  • Understanding of the elements of an 837I and/or 837P claim format and how those map back to the host system

  • Working knowledge of health care reimbursement practices, claims handling and health insurance benefit information and processes

  • Working knowledge of payer behaviors and the impact of contractual agreements to support the interpretation of contracts and payer requirements to operational stakeholders for continued success

  • Understanding of denials and 835 remittances and how it impacts the integrity of the patient account balance

  • Ability to communicate effectively with subject matter experts to ensure application usage and utilization meets needs of department

  • Ability to create training programs on new product lines, technology(ies) or modules that support the use and best practice of the system to optimize results in assigned modules

  • Experience and operational understanding of contract performance and related workflows in Meditech, Athena, JDA, and Med-Metrix preferred

  • Ability to stay informed of regulatory and compliance related changes that impact claims processing and revenue cycle processing as a whole

  • Ability to keep up to date with industry financial and system related advances

Job Duties and Responsibilities

• Review contracts to estimate reimbursement, identify possible interpretation issues and collaborate with necessary stakeholders involved in processing

• Coordinate and collaborate with billing, collections and appeals teams to confirm contract loads are producing anticipated results within applicable systems

• In coordination with IT resources build and maintain working knowledge on build, monitoring and optimization of contract management focused on functionality and system with applicable EPIC

• Is a resource for Managed Care and independently problem solves contract questions, including interpretation of contract language

• Stay up to date on claim submission requirements or changes based on government or regulatory programs initiated by payer(s)

• Review denial, underpayment and appeal data to produce actionable reporting and recommendations to operational stakeholders within the revenue cycle for areas of improvement

• Perform ad hoc analysis of contract performance and participate in committees associated with contracts and revenue cycle performance

• Complete and participate in projects related to new or closed service lines offered by the institution to serve as the subject matter expert related to charges and charging

• Other duties as assigned

About Us

Recognized as one of the 50 Top Cardiovascular Hospitals™ in the United States by IBM Watson Health™, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women’s health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the area’s only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks. For more information, visit halifaxhealth.org.