What are the responsibilities and job description for the PFS Business Process and Systems Analyst position at Bayhealth?
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Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader with hospitals in Dover and Milford, a s well as stand -alone Emergency Department in Smyrna and a hybrid E mergency Department and Urgent Care in Milton . We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore . Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!
Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:
- Generous Paid Time Off and Paid Holidays
- Matching 401(k)/403(b) Plans
- Excellent Health, Dental, and Vision
- Disability and Life Insurance options
- On Site Child Care
- Educational Reimbursement
- Health Care and Dependent Care Flex Spending Accounts
- Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!
Location: Kent Campus Hospital
Status: Full Time 80 Hours
Shift: Days
SALARY RANGE: 24.48 - 36.72HOURLY
General Summary:
Under the supervision of the Senior Manager this position is responsible for supporting accounts receivable processes, team member production, and quality for the various teams within Patient Financial Services (PFS). This position requires a high degree of proactive involvement and an analytical approach to appropriately identify and troubleshoot issues responsible for process breakdowns. Supports department operations and performs various reconciliations to ensure integrity and continuity of all claims, patient statements and presumptive charity by reconciling inbound and outbound files daily. Identifies and resolves errors in claim and statement files and reconciles collection agency inventory. Analyzes all Epic Watch List dashboard items, research issues and recommends resolution options to management. Provides project management related to system issues from reporting through to resolution. Participates in software upgrade testing and assists management in identifying concerns related to upgrades and/or new software. Creates an environment of accountability by generating and distributing reports for work queue monitoring and aged AR.
Responsibilities:
1. Claims, Statement and Propensity to Pay File Reconciliation: Responsible for reconciling all daily file transmissions. Reviews daily out and inbound file information to validate volumes. Works directly with Bayhealth IT or Clearinghouse to resolve identified file transmission issues; submitting management approved tickets as needed to Clearinghouse or Bayhealth IT department. Prepares and distributes monthly report to management on volumes.
2. Responsible for new payer EDI eligibility and claim enrollments with the clearinghouse. Learns and becomes the go-to-people for reports from the clearinghouse software. Submits Electronic Enrollments for all payers and clearinghouses for claims EDI (837) ERA (835) and EFT that are applicable.
3. Analyzes patients approved for financial assistance indigent adjustments quarterly to ensure adjustments are auto posted correctly and patients with approvals are set up correctly. Generates findings report to PFS Senior Management and Billing Support.
4. Agency Placement File Reconciliation: Reconciles placement and acknowledgement files. Performs inventory reconciliation with collections agencies. Compares agency’s reconciliation file to Bayhealth’s to identify and resolve discrepancies. Interacts directly with agencies on account and balance discrepancies to resolve variances.
5. Responsible for preliminary research of all components of Watch List dashboard and communicating issues to management for resolution. Works diligently to ensure any gaps in work queue logic are identified and resolved.
6. Evaluates Patient Financial Services, Denial and Appeal and Patient Access losses to identify root causes to reduce department related denials. Evaluates high volume Late Charge write offs determining root causes. Recommend changes to work processes to mitigate losses.
7. Investigates EPIC system issues reported by staff/management identifying root cause of issue if possible. Convert information gathered into clear concise facts. Determines volume and associated dollars to quantify impacts of identified issues to enable prioritization. Creates an accountable environment within the department related to issue accuracy.
8. Provides project management related to IT tickets. Responsible for submitting tickets to resolve system issues, tracking the status of tickets and communicating the resolution to management. Ensures PFS management responds to questions on their tickets and escalates internal performance issues to management.
9. Reviews software updates, participates in testing of system changes, upgrades, and new software installations. Assists managers in evaluating the impacts of upgrades/software changes that impact Billing, Follow Up and Billing Support.
10. Generates Billing and Claims work queue monitoring report monthly to all work queue users. Generates daily payment report by payer to track month-to-date payments. Distributes weekly payment report by payer to management.
11. Reviews and prepares agency invoices for manager approval; identifies inappropriate commissions on payments.
12. Evaluates generic insurance plan usage and employer table to identify insurance plans to add to Epic and employers to load into the table. Recommends controls along with the changes to improve front end accuracy of information.
13. Work with cash team to move files from payer folders to the splitter daily, submit Experian tickets for missing ERA files not received within 72 hours, resolve ERAs not received via Ach or paper, correct naming conventions on files received with Experian for proper payment posting, address corrections for checks being received with incorrect addresses.
14. Monthly meetings with Experian and Patient Access about corporate issues.
15. All other duties as assigned within the scope and range of job responsibilities
Required Education, Credential(s) and Experience:
- Education: High School Diploma or GED
- Credential(s): None Required
- Experience: Required: Five (5) years of revenue cycle experience in healthcare.
Preferred Education, Credential(s) and Experience:
- Education: Associate Degree
- Credential(s):
- Experience:
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