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Health Care Analyst/Lead: Charge Capture/Billing
Ref No.: 18-15144
Location: Emeryville, California

Health Care Analyst/Lead

Excel and EPC is key 
 

Knowledge, Skills and Abilities Req / Pref
Four (4) to six (6) years of experience in clinical charge capture, charge description master, coding, government/third-party reimbursement, or similar healthcare experience Req
Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle, specifically revenue integrity, and its component operations, including billing, coding, collections, charge capture, contractual adjustments, third-party reimbursements and compliance. Req
Experience in managing and/or developing charge description master or charge capture processes, policies, and/or procedures. Req
Knowledgeable in use and application of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Revenue codes. Req
Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle. Req
Detail-oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities and effectively address complex, urgent issues as they arise. Req
Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management. Skills in common database, spreadsheet and presentation software. Req
Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations. Req
Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions. Req
Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas. Req
Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on complex regulatory changes, and industry trends and developments in revenue cycle management. Req
Practical experience using hospital information systems, Epic billing system preferred, and computer proficiency with PC applications (e.g. Microsoft Office).

 
Req
%
of time
Essential Function (Yes/No)
Key Responsibilities
40% Yes Charge Capture
  • Liaisons with departments to thoroughly define reporting and information requirements. Identifies data source, develops and delivers routing and adhoc reports and presentations.
  • Acts as the charge capture subject matter expert and initial contact to assigned clinical areas. Evaluate revenue cycle inquiries and propose improvements or enhancements to system to maximize revenue.
  • Conducts and evaluates annual charge capture reviews and workflows to ensure consistent principles with coding, nomenclature and pricing for assigned cost center and/or new department creation. Collaborates with departments to design new workflows and conducts charge validation in order to maximize revenue.
  • Regularly reviews and updates charge capture related policies and procedures for assigned clinical areas.
  • Provides timely educational intervention in support of charge capture processes. Develops training materials for clinical area use and reference.
  • Conducts and leads regularly scheduled, on-site meetings with assigned service line clinical departments to ensure accurate and charge capture practices and workflows are in place; including daily charge reconciliation.
30% Yes Revenue / WQ Monitoring and Oversight
  • Monitors gross revenue metrics against established benchmarks for assigned cost centers; assist clinical department to identify revenue variance root-causes and mitigation of discovered issues and communicates to Service Line Special Lead and Revenue Integrity Manager.
  • Applies dashboard and other processes for continuous analysis of complex revenue cycle functions of diverse scope. Audit data input for validity and accuracy.
  • Work proactively with departments across the system to assure appropriate revenue cycle practices and compliance with internal and external regulations.
  • Performs daily review and monitors clinical department workqueues (APeX Charge Review, Account, and Charge Router Review workqueues, etc) and provide assistance to department representatives to resolve issues, as needed.
  • Actively resolved edits routing to Revenue Management owned work queues, performed ongoing trending and root-cause analysis.
30% Yes Other
  • Independently generate reports and analyze complex financial data. Identifies trends in revenue cycle operations and presents reports to all levels of hospital management and physician leaders. This includes, but not limited to, MyReports, Cognos, RevDash, Performance Portal, etc.
  • Collaborates with the Revenue Integrity CDM Manager to support ongoing CDM updates, preference list maintenance, or charge interface charging mechanisms.
  • Coordinates system related upgrades or application updates between assigned clinical areas and Information Technology department.
  • Collaborates with Advisory & Audit Services, Compliance, other internal/external auditor(s) to review results from retrospective and concurrent audits, develop an action plan to resolve discovered issues, and ensure implementation.
  • Engages Patient Financial Services (PFS), Health Information Management (HIM), and other departments to determine denials and work queue edits and mitigation plans.
  • Monitors and completes assigned APeX ServiceNow tickets. Ensures tickets are completed to the satisfaction of the end user.
  • Reviews Medicare intermediary and third-party payer bulletins, memos and websites to keep current on coding requirements, pending changes, and communicate relevant information to all applicable departments.
  • Performs other duties as assigned and appropriate to the position.