Business Analyst - Patient Financial Experience

Under limited supervision, the Business Analyst plays a critical role in pulling data from disparate systems, analyzing data, and improving processes and outcomes. The primary responsibility is to assess data and develop strategies to enhance operational efficiency and improve financial performance. This role supports both Revenue Cycle and Clinical Operations related to revenue leakage that occurs because workflow isn’t followed, workflow requires improvements or optimization, or requires collaboration with Managed Care Contracting and insurance companies to challenge policy and procedure for how they are processing claims. The role requires working with many different areas, facilitating meetings, and leading small projects that result in improvement of revenue leakage.

Responsibilities

• Collect, interpret, and analyze revenue cycle data (billing, coding, operational metrics) to identify trends, inefficiencies, and areas of improvement.
• Propose process improvements and partner with operational areas to implement them.
• Work closely with administrative, billing, clinical, IT, and operational leaders to improve revenue leakage.
• Escalate issues and status to leadership.
• Facilitate and lead workgroups, follow up on action items, present findings, and escalations to leadership.
• Lead initiatives to reduce write-offs with support from department leadership.
• Identify denial trends and perform root cause analysis. Categorize denials based upon root cause findings and distribute reports to applicable management and teams.
• Proactively work with multidisciplinary teams within the organization to develop procedures to reduce the number of denials received through reporting of denials and education of denial trends.
• Assist with establishing and implementing denied claims process improvement initiatives and maintain action plans to ensure objectives are met.
• Research, develop, and maintain a solid understanding of payer requirements, including filing limits, claim processing logic, coordination of benefits requirements, patient responsibility, and authorization requirements.
• Maintain a strong understanding of payer contracts and payment methodologies to identify their correlation to denied claims.
• Conduct relevant research on best practice methods to assist with completing the appeals process while staying informed with policy reforms, new regulations, billing changes, and accreditation/compliance requirements.
• Triage denied claims to identify those that should be appealed. Write timely, comprehensive, and compelling appeals to third-party payers to get denials overturned.
• Perform timely follow-up on filed appeals via telephone, writing, or the payer website.
• Perform other duties as assigned, including maintaining a current knowledge base of department processes, protocols, and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.

Requirements

• Bachelor’s degree required.
• 5+ years of experience in billing and/or denials management in hospital operations with a demonstrated understanding of revenue cycle, with an emphasis on billing, coding, charge capture, and reimbursement methodologies.

Skills

• Knowledge of medical terminology.
• Basic knowledge of CPT’s, HCPCS, and Revenue Codes.
• Basic knowledge of major insurance companies' billing policies to ensure compliance.
• Advanced knowledge of payor remittances.
• Basic knowledge of insurance claim forms.
• Advanced skills in MS Office, including Word and Excel. Working knowledge of PowerPoint.
• Experience analyzing billing data in Epic.
• Strong analytical skills necessary to collect, analyze, and interpret denials data, and resolve complex problems.
• Ability to organize, prioritize, and manage multiple priority projects simultaneously.
• Highly motivated, self-starter with attention to detail and accuracy, and excellent written, verbal, and interpersonal skills.
• Ability to work in a team environment as well as independently.
• Knowledge of health system regulatory guidelines, standards, and experience in a healthcare setting strongly desirable.
• Commitment to team support, participation, and excellence.
• Ability to work with various levels of personnel, demonstrating tact and discretion when receiving and relaying information.