Revenue Cycle Operations Analyst

Location: Kent Campus Hospital, Dover Delaware

Status: Full Time 80 Hours Biweekly (Exempt)

Shift: Days

SALARY RANGE: 65,000.00 - 100,734.40 YEARLY

General Summary:

The Revenue Cycle Operations Analyst supports the employed physician Patient Financial Services team in claims, accounts receivable, underpayment and denial management reporting analytics. Develop reports in Epic to monitor physician accounts receivable and payer performance at the practice level to track revenue, denial, and overall financial performance. Analyzes large datasets to identify trends, variances, and opportunities for revenue enhancement. Supports analytics with account review findings to identify root cause and validate issues. Benchmarks revenue department performance against like departments/practices.

The ideal candidate is a detail-oriented data analyst who can turn data into actionable information providing all reporting in a timely manner to leadership to support business decisions and prioritize needs. Epic experience is required to enable optimal report writing within the Epic framework and have a willingness to continuously develop and acquire new technical skills. Must be able to communicate effectively with stakeholders to prioritize work efforts.

Responsibilities:

1. Provides utilization, profitability, yield analysis, and bad debt for all physician practices and care centers. Develops and produces a quarterly practice scorecard for all practice locations.
2. Tracks, trends, and validates all claim and denial volumes, payment timeliness monthly by claim type and payer. Analyzes root cause of denials and communicates with respective leadership supporting mitigation efforts. Produces Access denial scorecard by hospital department/physician practice trending eligibility, authorization and coordination of benefit denials. Produces medical necessity denial report by ordering physician. Trends ABN overrides by department/procedure. Produces time-to-payment report for all contracted payers.
3. Reconciles surgeon RVUs and hospital denial losses and provides report to Revenue Cycle and Finance leadership.
4. Provides payment variance reporting, including, but not limited to: Provides monthly report of underpayments for contracted payers by payer, provides monthly report trending ER visit downgrades by payer, provides monthly report trending evaluation and management visit downgrades by payer. Validates all findings and recommends changes based on payer behavior to better identify payment variances.
5. Productivity Benchmarking, including, but not limited to: Tracks productivity based on accounts worked/touched in Epic against hours worked and budgeted FTEs for physician revenue cycle team. Compare performance to departmental and industry benchmarks. Works with management to develop and refine departmental labor standards.
6. Produces monthly point of service collection report by practice and distributes it to practice leadership.
7. Produces monthly reporting package by clinical division for leadership, includes, but isn't limited to: Accounts receivable aging report, Denial reports by reason code and payer, Revenue and payment reports by practice.
8. All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s) and Experience:

• Education:
• Bachelor Degree Business
  ; Or Healthcare Administration.
• Credential(s): None Required
  ;
• Experience:
• Required: Five (5) years Physician Revenue Cycle Experience or Data Analytics and Report Writing
  Preferred: Medical Revenue Cycle Analytics Experience

Preferred Education, Credential(s) and Experience:

• Education: Master Degree
• Credential(s): Certified Revenue Cycle Professional
  Certification related to the position, if applicable.
  
  Epic revenue cycle and/or reporting writing certifications
• Experience:

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