Revenue Cycle Analyst

Job Description 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 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. Job Type: Full-time Salary: $65,000.00 - $73,000.00 per year Responsibilities Relation to Mission The mission of Sun River Health is to increase access to comprehensive primary and preventive health care and to improve the health status of our community, especially for the underserved and vulnerable. Equal Employment Opportunity Sun River Health provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, sexual preference, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function. Americans with Disabilities Act Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law. Job Responsibilities The following statements reflect the general duties, responsibilities and competencies considered necessary to perform the essential functions of the job and should not be considered as a detailed description of all the work requirements of the position. Sun River Health may change the specific job duties with or without prior notice based on the needs of the organization. About Us Sun River Health is a network of 43 Federally Qualified Health Centers (FQHCs) providing primary, dental, pediatric, OB-GYN, and behavioral health care to over 245,000 patients annually. With a dedicated staff of 2,000 doctors, nurses, and health care professionals, we pride ourselves on delivering high-quality, affordable care to those who need it most. Sun River Health started in 1975 when four African American mothers spearheaded efforts to open our first health center in Peekskill, New York to deliver accessible, high-quality, affordable services to patients in need - no matter their race, religion, income, or insurance status. Today, after 45 years of service, Sun River Health is still delivering on that promise to communities across the Hudson Valley, New York City, and Long Island.

Created: 2024-11-19