Revenue Cycle Analyst
This job profile is not included in a recognized pathway.
Description
This position is responsible for overseeing and coordinating revenue cycle operations and activities towards organizational goals to maximize coding, billing, and reimbursement in a cost-effective manner that follows federal, state, and payer-specific requirements and regulations. This position will work with the TPA to develop and oversee the overall revenue cycle policies and procedures meeting the organizations strategic planning of revenue cycle activities to optimize the patient financial interaction and delivery of care model. This position is also responsible for working with the TPA in regard to maintaining active status for all providers and facilities by successfully completing initial and subsequent credentialing packages as required. Assists providers and TPA with maintaining NPI, CAQH, licensures, trainings, and other requirements for credentialing and privileging. Verifies all credentials and licenses are valid and up to date.
Tasks
- Facilitate communication between company and billing TPA such as:
- Denial cleanup
- Unlocked/missing encounters
- Resolve actionable and informational unpaid claims
- Credentialing and contracts
- Scanning daily deposits and payment backup for eCW posting
- Coordinate refunds
- Coordinate cost report and rate updates such as Medicaid PPS, Wrap and Medicare Wrap
- Assist with provider, nurse or front desk training based on shared priorities
- Analyze and distribute audit results
- Coordinate external audits
- Coordinate month end close
- Assist with de-escalation form patient bills/complaints
- Assist with vendor management including clearinghouse, eCW and Bill Flash or similar patient statement co.
- Facilitate communication between company and TPA for payer enrollment and credentialing such as:
- Ensures maintenance of provider files, including, but not limited to: Board certification requirements; maintaining registration, DEA and licenses, NPDB; coordinate with outside entities where providers maintain privileges.
- Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available and maintained.
- Work with providers and TPA to ensure each provider’s CAQH database files are updated timely according to the schedule published by CMS Medicare/Medicaid and Managed Care Organizations regulations.
- Coordinate assistance with new providers and TPA completing applications for National Provider Identifier (NPI).
- Notify TPA for terminating enrollment with government and commercial payers upon resignation or termination of providers.
- Oversight for coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies with TPA
- Work closely with TPA to ensure all providers are credentialed and recredentialed timely.
- Coordinate with TPA to research, analyze, and evaluate credentialing applications, ensuring all relevant information has been submitted; distribute and receive applications.
- Ensure credentialing applications are tracked and monitored for adherence to timelines.
- Monitor and document credentialing efforts.
- Ensure applications are processed thoroughly and expediently.
- Make recommendations on improvements to the credentialing policies and procedures, based on experience and/or evolving regulatory requirements.
- Assist with compliance and preparation for HRSA, including site visits.
- Participate in staff development to maintain skills.
- Independently use problem solving techniques to resolve issues related to the completion of duties.
- Perform other duties as assigned.
Qualifications / Education
EDUCATION/EXPERIENCE
- High School Diploma or equivalent required
- Two (2) years of administrative experience in a health care setting is required
- Coding certification is required
- Bachelor’s degree in a health or business related field preferred.
- Must posses excellent professionalism, interpersonal skills, customer service skills, written and oral communication skills, listening skills, and organizational skills
- Ability to work as a member of team with self-initiative
- Ability to perform several tasks together and complete given assignments timely and accurately
- Experience with Microsoft Office Suite required
