Welcome to Shared Services, our team uses a coordinated approach to delivering administrative and operational services across Lahey. Our Shared Services colleagues leverage resources across the organization to ensure we provide high-quality, high-value care to the communities we proudly serve. The Shared Services team includes colleagues who focus on business and network development, legal services, facilities and real estate, human resources, information technology, finance, philanthropy and marketing and communications.
About the Job
Under the managerial oversight of the Senior Manager the Revenue Performance Analyst serves as a primary point of contact for Billing Director, Service Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, colleagues and others regarding matters that relate to aspects of professional revenue and other matters relating to professional revenue cycle and modality specific billing processes and/or workflows. The Revenue Performance Analyst is responsible for working closely with the Service Line Directors and Practice Managers of their assigned specialties to optimize and coordinate revenue cycle/billing activities. The ultimate goal for this position is to ensure optimal A/R performance by practice. This position will provide strategic guidance to optimize reimbursement and reduce denials. 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 the contact and advocate between assigned Service Line Directors and Practice Managers while representing Patient Financial Services and its processes and workflows.
- Serves as the contact between Coding, HIM, ADT, CM, Contracting, Finance, and Revenue Cycle Leadership.
- Proven analytical skills needed to prepare and analyze monthly reports for each department’s specialty. Locate patterns and trends by focusing on high volume denials that have a common denominator. Analyze root cause and determine where efforts need to focus; physician documentation, charging, system edits, payer billing guidelines, workflows etc. Write a detailed summary of issues including recommended course of action to resolve denial.
- Communicate results of analysis, including root cause and resolution, to Service Line Directors and Patient Financial Services Senior Leadership.
- Analyze and trend monthly write offs by specialty with a goal to reduce write offs. Communicate results to all parties including Service Line Directors and Patient Financial Services leadership.
- Facilitate a meeting to involve sub groups of members tasked with determining corrective steps to resolve and avoid denials.
- Attends all scheduled meetings that relate to specific specialties and billing workflows and or processes. Communicates minutes to Patient Financial Services Senior Leadership.
- Develops and distributes weekly, monthly and ad hoc reports needed by Revenue Cycle Leadership and Finance.
- Document and maintain department/specialty specific facts, unique charging scenarios and tips to process and appeal denials.
- Responsible for researching payer billing guidelines for specific services related to potential new business or existing services that require current billing guidelines. Results are documented in a template with specific details including, but not limited to, payer policies.
- 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.
- 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 outstanding accounts receivable and credits and ensures that these are maintained at the levels expected by Revenue Cycle Leadership.
- 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.
- 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).
- Respond to questions relative to all reimbursement issues, rejections, and/or billing problems.
- Educates/shares information with the Physicians, Coders, Clinical staff and PFS staff regarding billing operations and 3rd party regulations.
- Provides training and education to Patient Financial Services Managers and their respective teams with a goal to accurately process appeals and reduce denials.
- 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.
- Responsible for appealing and defending claims denials, adverse audit results, and sanctions.
- 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.
- 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.
- Bachelor’s Degree or Equivalent Experience Required.
Licensure, Certification & Registration:
- Epic proficiency or certification in Resolute PB desired
- 3 - 5 years of clinical, healthcare operations, revenue cycle experience
- Experience in a healthcare setting, ability to understand and document business processes, ability to multi–task, problem solve and experience managing projects with defined scope and duration.
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.
- Ability to create, analyze and interpret financial reports.
- Ability to define problems collects 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
Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve. Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health. Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.