Key Facts

Remote From:

Full time

English

Hard Skills

Medical Billing Account Analysis Medical Coding Claims And Litigation Management Revenue Management Hospital Information Systems Payment Processing Reimbursement Regulations Accounts Receivable KPI Management Insurance Follow-Up Claims And Litigation Management Privileged Access Management Contract Management Microsoft Operating Systems Documentation Generation Data-Driven Decision Making Escalation Procedures

Other Skills

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Collections
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Microsoft Word
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First Aid
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Microsoft Excel
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Analytical Skills
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Teamwork
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Telephone Skills
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Detail Oriented
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Verbal Communication Skills
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Problem Solving

Roles & Responsibilities

One year of experience in revenue cycle analysis within the healthcare industry (infusion preferred).
Minimum high school diploma or GED; post-secondary education in a medical discipline highly desired.
Strong analytical skills and attention to detail; ability to work independently and as part of a team.
Familiarity with healthcare IT and revenue management software; knowledge of Windows, Word, and Excel is highly desirable.

Requirements:

Ensure accurate coding, charge capture, and billing practices in compliance with CPT, ICD-10, and HIPAA.
Collect data from clients daily or weekly to generate claims using various software platforms; manage and monitor claims to maximize timely and accurate reimbursement, including claim submissions, denial management, and appeals.
Track claims pending due to missing or incomplete documentation and ensure claims are submitted promptly within filing periods; perform follow-up calls to insurance providers for claims not settled within 30 days or standard processing times; timely submission of appeals.
Analyze payer contracts and fee schedules to ensure proper reimbursement and identify opportunities to enhance revenue capture and reduce revenue leakage; document notes clearly in the client software and report issues to management.

Job description

The Revenue Cycle Analyst will play a vital role in optimizing the revenue cycle process. This position is responsible for analyzing and managing various aspects of the revenue cycle process, including billing, collections, coding, and reimbursement. The successful candidate will have a keen eye for detail, exceptional analytical skills, and a deep understanding of medical billing and collections.

Qualifications:

Desired one Year experience in revenue cycle analysis within the healthcare industry, preferably in infusion.
Minimum of a high school diploma or GED is required.
Post-Secondary education in a medical discipline highly desired.,
Knowledge of Windows, Word, and Excel is highly desired.
Excellent telephone and communication skills essential.
Strong analytical skills and attention to detail
Familiarity with healthcare IT and revenue management software.
Ability to work independently and part of a team.
Not required but desired experience with CPR+, Caretend, Weinfuse, HcN360.
The ability to use logic as a problem-solving skill, and able to recognize trends to make decisions to improve business.

Duties and Responsibilities:

Ensure accurate coding, charge capture, and billing practices in compliance with industry standards (i.e., CPT ICD-10, HIPAA)
Collect data from our Clients daily or weekly, to generate claims using various software platforms.
Manage and monitor claims to maximize timely and accurate reimbursement, including claim submissions, denial management and appeals.
Identify opportunities to enhance revenue capture, minimize revenue errors, and reduce bad debt through analysis of key performance indicators.
Analyze payer contracts, fee schedules and reimbursement to ensure proper reimbursement is made on paid claims.
Track claims that are pending due to missing or incomplete documentation (i.e.: DIF, RX, authorization, etc.).
Ensure claims are submitted promptly to insurance companies within their specified filing period.
Regularly make follow-up calls to insurance providers to check the status of claims not settled within 30 days or their standard processing time.
Timely submission of appeals to secure correct payment for outstanding claims
Address partial payments and denials promptly while also submitting and following up on secondary claims for resolution.
Deliver outstanding communication to clients bother verbally and in writing.
Recognize and report any issues or patterns to management as necessary.
Work claims rejected in the claim’s clearinghouse and resubmit them as required.
Ensure that notes are recorded within the client’s software platform in a clear, concise, and timely manner.
Additional duties as assigned.