Business Operations Analyst

Location: 2400 Unser Blvd, Rio Rancho, NM 87124

About the Role

We are seeking a skilled Business Operations Analyst to work in direct coordination with the Revenue Management Department. This role focuses on maintaining the financial health of services through proactive audits, billing processes, and compliance with payer regulations.

Responsibilities

• Perform proactive daily audits of patient billing, identify discrepancies, and execute corrective actions.
• Initiate billing processes for administration (procedures), drugs, and equipment used in patient care.
• Identify and facilitate Charge Description Master (CDM) adjustments in response to Medicare, third-party, and other payer regulations.
• Ensure compliant CPT4, ICD9, and HCPCS coding.
• Monitor changes in the Federal Register relating to reimbursement of services/products provided.
• Direct data acquisition and assess gathered data to produce area measurements, quality statistics, and improvement efforts.
• Manage change initiatives, educate and prepare staff accordingly.
• Provide input into the development budget, departmental goals, policies, and procedures; assist in ensuring the department operates within budget.
• Counsel patients on financial responsibilities, costs of treatment options, and set up payment plans as necessary.
• Maintain effective public relations with patients, physicians, and the public.
• Coordinate with the Central Business Office and Revenue Management Department to ensure compliance with third-party payers and regulations.
• Stay current with developments in medical oncology through seminars, workshops, and publications.
• Oversee and maintain follow-up procedures to ensure timely billing.
• Review problem bills to determine causative agents, resolve issues, and take action for rebilling or corrections.
• Review incomplete Medical Record Reports to ensure compliance with PHS and Medicare policy.
• Audit patient accounts for billing errors, research errors, and intervene to make corrections.
• Maintain current knowledge of reimbursement and billing practices of third-party and private insurance payers.
• Evaluate changes/updates to FDA-approved drugs and treatments to ensure proper reimbursement.
• Maintain appropriate billing procedures and ensure accounts receivable records are kept in accordance with established procedures.
• Assemble, prepare, and distribute relevant information to facilitate further processing.

Qualifications

• Associate’s Degree, Diploma in business, or three to five years of experience in a healthcare reimbursement/business office environment.

Pay

Pay Range Minimum Offer: $50,481.60
Maximum Offer: $85,966.40

Benefits

• Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, and group term life insurance.
• Optional voluntary benefits.
• Employee Wellness rewards program offering gift cards and incentives for participation in wellness activities (e.g., challenges, webinars, preventive screenings).

Schedule

Full-time, exempt position.
Work Shift: Days (United States of America).
Based at Presbyterian Rust Medical Center.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. As a locally owned, not-for-profit healthcare system, we operate nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees, including more than 1,600 providers and nearly 4,700 nurses. Our health plan serves over 580,000 members statewide, offering Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.