Data Analyst

Job Description

JOB SUMMARY:

The Revenue Cycle Management (RCM) Operations Specialist, under the direction of the RCM Manager, performs the daily activities of analyzing, identifying, and solving complex reimbursement issues and trends within Revenue Cycle Management. The Revenue Cycle Management Operations Specialist is diverse in all aspects of Revenue Cycle Management workflows, Billing Compliance and Testing, Insurance Billing, Insurance Collection, Payment Posting, Client Support Services, and Patient Support Services. The Revenue Cycle Management Operations Specialist will also work closely with RCM Manager to complete special projects as needed.

JOB RESPONSIBILITIES

ESSENTIAL FUNCTIONS:

• Responsible for the review and follow-up of outstanding accounts and projects, adhering to productivity guidelines as established by Revenue Cycle Management.
• Analyze and review queries/reports to identify payor reimbursement, rejections, and trends.
• Assist with payor audits and payor pre-payment reviews.
• Effectively communicating with payors to resolve contract issues regarding reimbursements rates and/or improper denial patterns.
• Responsible for cataloging and maintaining current payor policies and guidelines.
• Maintain Revenue Cycle Management’s internal policies.
• Serve as liaison between Revenue Cycle Management and Sales/Marketing for high sensitive client accounts.
• Serve as project leader in the development and implementation of training manual/materials, and Quality Assurance programs.
• Assist with the implementation and testing of all upgrades to existing applications, as well as new applications/modules.
• Analyze, identify, and offer resolutions for Revenue Cycle Management issues generated from client data interfacing.
• Must be familiar with and abide by the Corporate Compliance Program and all corporate policies, including the Privacy and Security policies.
• Perform all job responsibilities in alignment with the industry’s best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.

NON-ESSENTIAL FUNCTIONS:

• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.

Requirements

EDUCATION LICENSURE:

• High school diploma or GED is required.
• Associates degree preferred.

REQUIREMENTS:

• Five years of prior job-related experience is required.
• Experience with healthcare Revenue Cycle Management solutions is required.
• Knowledge and understanding of payor fee schedules and payor contracts required.
• Must be efficient with Microsoft Office applications: Outlook, Word, Excel, Teams, PowerPoint, etc.
• Must be familiar with governmental rulings, including NCCI, LCD, and NCD policy regulations and guidelines.
• Experience in anatomic pathology and clinical laboratory billing preferred.
• Experience with medical insurance and payor relations interaction is preferred.
• Knowledge of system interfacing is preferred.

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