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Revenue Cycle Analyst


Department Description: Seeking financial analyst for revenue cycle department. Position is located at 1135 Tremont St.

Job Location: Boston, MA

Req ID: 39837BR


Job Summary: Under the direction of the Director of PFS, evaluates unresolved third party claims due to bill processing or coding edits, rejections, denials or payment variances to determine root causes and takes necessary steps to resolve issues identified. This position provides support to members of the Patient Financial Services, Audit and Underpayment Teams for account resolution.

Essential Responsibilities:
  1. On a systematic basis, analyzes the information in the department's pre-bill, coding rejection and denial edit databases for unresolved third party claims to determine root causes for the edit issues and potential resolution with the originating departments and/or the PFS clinical coding staff.
  2. Reviews denials to appropriately rebill and appeal back to payers to ensure that the correct reimbursement is obtained for the services rendered to BIDMC patients.
  3. Working with the many departments and the results of the analysis, identifies with the Director workflow improvements in the manner with which the edits, accounts, denials are handled encouraging automated resolutions whenever possible. Additionally, evaluates third party retractions to determine the validity, and files disputes when appropriate to recoup the withdrawn revenue from the payer.
  4. Working with the Director, assists in the data review of CMS and third party payer audits and prepares responses and appeals based on this review and analysis.
  5. Maintains Payer database to track and report issues for the purpose of root cause analysis, follow up, revenue recovery, and resolution identification.
  6. Other tasks and work as assigned.
Required Qualifications:
  1. High School diploma or GED required. Bachelor's degree preferred.
  2. 3-5 years related work experience required in health Insurance billing and coding, receivables management, collection and data processing interface experience..
  3. Demonstrate collaborative and respectful behavior and partner with all team members to achieve goals.
  4. Receptive to others' ideas and opinions and have a flexible schedule to be able to support department needs.
  5. Demonstrate accurate, clear and timely verbal and written communication and actively promote teamwork and work ethics and maintain confidentiality at all times.
  6. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
Competencies:
  1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
  2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
  3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
  4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
  5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
  7. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
  8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
EOE Statement

BIDMC is EOE M/F/VET/DISABILITY/GENDER IDENTITY/SEXUAL ORIENTATION

Vaccines

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. BILH requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement

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