Associate Revenue Cycle Analyst - Claim Rejections

The Associate Revenue Cycle Analyst is responsible for investigating and resolving complex front-end billing issues that impact claim acceptance and reimbursement. This role focuses on EDI rejections, insurance verification, and claim submission errors to ensure claims are submitted accurately and accepted by payers.

Job Responsibilities:

• Serves as a source of knowledge for front end billing and claim rejections.
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.
• Assist with developing appropriate workflows and tracking for the designated revenue cycle function.
• Establishes an ongoing working relationship with other departments impacting revenue cycle performance.
• Works closely with the vendor operations teams to oversee operations activities that directly impact the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
• Continuously reviews and monitors billing and coding changes, and researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
• Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.
• Supports goals and metrics to link department and revenue cycle initiatives with the organization's strategy.
• Develops, manages and monitors successful completion of implementation and project plans.
• Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.
• Continues to seek new and creative technologies that help identify and guide improvement opportunities that align with overall company success.

Qualifications: 

• Bachelors Degree in business or healthcare related field of study preferred.
• At least 2-3 years of experience in medical billing and Insurance collections.
• Basic knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.

Required Knowledge, Skills and Abilities:

• Proficiency with medical billing systems, Microsoft Excel, medical terminology and basic procedure coding knowledge.
• Proficient in spreadsheet development (VLOOKUPS, pivot tables, etc.)
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Strong communication (verbal and written), organizational, problem solving and team player skills.
• Ability to navigate across multiple customer demands and balance competing priorities successfully.
• Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner.
• Ability to solve problems using critical thinking skills.
• Maintains confidentiality of sensitive information.
• Analytical skills required.
• Ability to think critically and identify the impact across the revenue cycle with a solution-oriented approach.
• Ability to develop, implement and produce analysis and reports