Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who see it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia, Westchester Counties and New York City. Solutions 4 Community Health, (S4CH) is a wholly owned entity of Sun River Health. Solutions 4 Community Health (S4CH) provides management solutions for health care safety net providers to improve their care delivery and outcomes, sustainability and efficiency and is currently seeking a full-time remote Revenue Cycle Analyst.

Will work directly with the payers to identify and escalate problems and issues as needed. They will be responsible for the identification and analysis billing issues, as well as participating in training programs for physicians and staff to increase knowledge and skills related to the revenue cycle. They will maintain a current knowledge of payer guidelines, fee schedules, contracts, quality incentives and system knowledge including ECW, Cognos and Claim Remedi.

Responsible for the identification and analysis of billing issues

Maintain a current knowledge of payer guidelines, fee schedules, contracts, quality incentives

Maintain a system knowledge including ECW, Cognos, Spotfire and Claim Remedi/Waystar

Review Accounts Receivable and give summary on weekly/monthly basis to supervisor of payor issue

Identify, communicate, resolve interruptions in the revenue cycle that prohibit maximized reimbursement. This would include trending provider, front desk errors, clearinghouse, payer CAS/remarks and follow-up of such issues.

Build, troubleshoot, and maintain front end and workflow rule engines

Open & manage vendor tickets for all client, communicate with revenue cycle management resolutions and other issues as needed

Assist with monthly self pay and LOB scrub reports

Assist Supervisor of Revenue Cycle to ensure denials are worked and appealed as appropriate

Coordinate and or participate in regular coding, registration and/or site-wide audits for all clients as well as provider education

Coordinate and analyze automated denial management workflows including but not limited to Medicaid automation tools, and other automated programming

Assist in overseeing, developing, & analyzing specific eCW tasks

Provide analytics and trends for client monthly Executive meetings

Update all ecw client setup to be consistent across databases (claim status, insurance names/classes, cpt group, etc)

Continue to analyze AR and assist in denial management to reduce the life cycle of claim, and assist Manager of Revenue in developing training protocols for billing staff

Monitor automated processes to ensure 100% successful file completion.

Innovate new automated processes to help make denial management more efficient

Create training materials on the automation process and continue to train staff when needed on this process.

Assist in identifying missed revenue options and working with management to resolve and increase revenue for clients

Responsible for running regular reports (including monthly 4028 observation & Medicaid claim reports, if applicable), which includes but is not limited to filtering, uploading to robotics, checking and correcting any errors and sending to the appropriate recipients

Complete special projects and report findings to management

Run, analyze, and correct errors for assigned robotic reports

Run, analyze, trend and report on assigned observations

Handle follow-up and appeals with assigned payers for unpaid, denied and underpaid claims

Responsibility for designated A/R team. Supervises daily operations of assigned payers and follow up, including attendance and annual reviews. Create a positive team environment.

Participate in training programs for physicians, client and staff to increase knowledge and skills related to the revenue cycle

Assist with complete A/R analysis and trends for all services, insurance plans and/or specialties and provide findings to management

Complete assigned audits and communicate findings to management

Run monthly insurance over/under payment analysis reports and provide findings to management

Review denial management processes with management with a goal to improve Revenue Cycle

Work directly with the payers to identify and escalate problems and issues as needed

Additionally, they will work directly with the payers to identify and escalate problems and issues as needed. They will be responsible for the identification and analysis billing issues, as well as participating in training programs for physicians and staff to increase knowledge and skills related to the revenue cycle. They will maintain a current knowledge of payer guidelines, fee schedules, contracts, quality incentives and system knowledge including ECW, Cognos and Claim Remedi.

Qualified candidates will have a minimum of five to eight years of experience in billing or revenue cycle management in either a physician practice or other similar setting.

High School Diploma/GED is the minimum education requirement. A Bachelor's Degree and or equivalent experience is preferred. Certification in Coding (CPC) is required through the AAPC. Possessing knowledge of New York State Department of Health programs or federally qualified health center operations considered advantageous. Demonstrated experience working in a diverse employment setting working collaboratively with other employees of Sun River Health considered an advantage.