Revenue Cycle Operations Analyst

Primary job function is the acceleration of cash flow and reimbursement enhancement within the revenue cycle, reporting directly to the Vice President – Revenue Cycle. All Employees of Southeast Georgia Health System will promote a culture of safety, follow established policies, and adhere to all state and federal regulatory requirements, Joint Commission requirements, and national patient safety standards.

Essential Responsibilities:

• Works with the public, physicians, attorneys, industry, health system management and the appropriate outside agencies to determine process and procedure changes which will enhance operations and resolve customer satisfaction issues to meet the needs of the patient.
• Identifies and implements cost saving initiatives. Evaluates Patient Financial Services’ processes by assignment to enhance operational efficiency, staff utilization and performance of vendors contracted to provide revenue recovery functions on behalf of the Health System.
• Maintains oversight responsibility for specialty billing, managed care contract performance, claim denials, reimbursement validation and reimbursement/refund processing.
• Researches, evaluates and recommends new technology and services for process improvement. Provides statistical data for analyzing the revenue cycle and trends payer reimbursement. Provides annual budget data and prepares monthly financial reports as requested.
• Responsible for determining and implementing controls to ensure Patient Financial Services adheres to regulatory and legal standards pertaining to JCAHO, insurance billing and credit/collections. Conducts staff training as necessary. 
• Conducts reimbursement, adjustment posting and credit balance refunding audits. Directs staff and initiates discrepancy resolution as appropriate. Collaborates with Business Development in validation of managed care and specialty billing payment issues and ensures payer contractual obligations are met as agreed upon.
• Maintains current knowledge of governmental and commercial regulatory directives in the pursuit of recovering loss reimbursement. Collaborates with associated departments to appeal denied claims, file for outliers and to conduct education events as needed for medical and management staff.
• Maintains, initiates, and updates policies/procedures for the Patient Financial Services in accordance with Joint Commission, HIPPA, regulatory compliance and established best business practices.
• Accepts direct supervisory assignments over Patient Financial Services’ coordinators, supervisors and staff to evaluate and improve processes to accomplish departmental goals.

Minimum Qualifications:

Education:         

• Bachelor's Degree required.

Experience:       

• Five years credit-collection/insurance/accounting experience in health care field.

Licensure:          

• Professional certification – Certified Patient Accounts Representative (CPAR) preferred.

Knowledge/Skills/Abilities:       

• Supervisory skills
• Demonstrates discretion and sound judgment and awareness of budgetary responsibility. 
• Exhibits positive interpersonal skills (customer service); 80% of the time is spent interacting with others.
• Proficient in all areas of billing and collection of accounts receivable, managed care contracting, claim reimbursement validation and payment dispute resolution.