Lahey Health Shared Services is part of a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.
We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.
About the Job
Under the managerial oversight of the Director, Senior Manager, or Manager of Revenue Cycle, the Revenue Cycle Analyst serves as a primary point of contact for Service Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, hospital colleagues and others regarding matters that relate to aspects of of professional and hospital revenue and other matters relating to professional and hospital revenue cycle and modality specific billing processes and/or workflows. Responsibilities are performed independently within established department policies and procedures, this position is responsible for improving revenue cycle workflow, efficiency, accuracy, reimbursement, and overall revenue control through operational and system enhancements and/or modifications. Responsible for developing an environment of customer service, continued learning and increased communication within revenue cycle and between hospital departments. Throughout the revenue cycle and across the Lahey healthcare organization, the RCA will be responsible for coordinating revenue cycle policies, practices, identifying issues, trends, and provide solutions.
Essential Duties & Responsibilities may include but not limited to:
- Serves as revenue cycle liaison between Service Line Areas, Coding, HIM, ADT, CM, Contracting, Finance, and Revenue Cycle Leadership.
- Responsible to advise and assist with revenue operations as they relate to Epic build decisions, in-depth analysis of denials, complex appeals, audits, credits, cash, coding, workflows, data collection, report details, claims and remittance set up, logic and processing and applicable technical issues.
- Analyzes outstanding accounts receivable and credits and ensures that these are maintained at the levels expected by Revenue Cycle Leadership.
- Responsible for appealing and defending claims denials, adverse audit results, and sanctions.
- Analysis, track and trend daily, weekly, and monthly denials by payer using denial reporting tools. Maintain a system of reporting that provides timely and relevant information on all aspects of clinical appeals, audits, and compliance issues to Revenue Cycle Leadership. Develops and distributes weekly, monthly and ad hoc reports needed by Revenue Cycle Leadership and Finance.
- Provides in depth knowledge and determines best Epic system build options and functionality that will help improve revenue cycle operational workflows and system usage and understand the choices involved in application configuration; collects and reports information to Revenue Cycle Leadership regarding potential system enhancement needs and system breaks/fix issues.
- Analyzes work queues and other system reports and identifies denial/non-payment trends, reports and provides recommendations to the Revenue Cycle Leadership.
- Maintains thorough knowledge of EDI claims and remittances, payer billing requirements and policies, regulatory changes in the healthcare environment. Keeps abreast of all payers and payer level professional and/or hospital coding, billing and reimbursement rules, regulations and guidelines.
- Participates in complex projects related to denial initiatives and complex investigations into allegations of billing fraud or abuse, as necessary. Provides support for projects in which Senior Leadership is involved.
- Conduct regular audits to ensure that LHS is coding, billing and documenting completely and accurately and are in compliance with all applicable federal and state laws and regulations.
- Proactively identifies problems or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective departments with high volume/high dollar values.
- Develop, trend, and report monthly and annual statistical reporting dashboard to coincide with departmental and organizational KPIs (Key Performance Indicator).
- Representation at scheduled meetings with assigned payers and provider representatives to address all outstanding claims processing issues. Maintain an ongoing issues tracker for each payer in order to communicate and trend all issues and communicate with contracting any and all contracting related problems.
- Associates Degree preferably in the business or finance field
- In the absence of an Associate’s Degree, an additional 4 years of healthcare revenue cycle experience above the five identified below are required.
Licensure, Certification & Registration:
- Epic proficiency or certification in Resolute HB and/or Resolute PB desired
- Requires minimum 2 years of healthcare revenue cycle experience
Skills, Knowledge & Abilities:
- Comprehensive working knowledge of medical/hospital billing practices, billing software, health care insurance, and CMS regulations
- Knowledge of CPT, HCPCS, and ICD-10 coding principles.
- Knowledge of Epic or related hospital ADT/Billing software.
- Thoroughly proficient in data entry using a pc and a variety of electronic systems.
- Ability to read, analyze and interpret financial reports.
- Ability to define problems, collect data, establish facts, draw conclusions, and make sound recommendations.
- Capacity to analyze and think creatively and weigh alternatives.
- Perception of people and an awareness to deal with conflict successfully and attain resolution
- Demonstrates attention to detail.
- Demonstrates excellent organizational skills.
- Demonstrates skills with multitasking
- Demonstrates proficiency in the use of excel documents
The Lahey Model of Care—right care, right time, right place—is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.