Revenue Cycle Analyst II - Payer Contracts

Location

Daytona Beach, FL | United States

Job description

Halifax Health is seeking a Revenue Cycle Analyst II - Payer Contracts for the PBFS - Administration Department.

The Revenue Cycle Analyst II – Payer Contracts will perform various functions to support the build, validation and ongoing updates of payer contracts for Halifax Health within assigned electronic systems. This role will work closely with the IT department as part of and post EPIC implementation to build as well as validate the accuracy of payer contracts loaded into applicable technology systems. This role will hold a technical and operational relationship with any third-party vendor that we utilize to model, re-model or update payer contracts. This role will support end-users in the managed care department who interact with claims data that results in underpayments or denials reporting based on expected reimbursement from contract language.

• Requires minimum bachelor’s degree or higher in business administration, finance, computer science or healthcare related field. Equivalent experience in related role will be accepted
• Requires 5 years of revenue cycle experience minimum
• Experience in at least one Epic module: Prelude, Cadence or Grand Central (preferred, not required)
• Certification in applicable Epic module (preferred, not required)
• Experience with EPIC payer contract processes preferred
• Requires skills in the following areas:
  • Strong interpersonal skills
  • Analytical skills
  • Customer service
  • Problem-solving
  • Innovative thinking
  • Microsoft Office Applications
  • Requirements gathering and documentation
• Experience
  • Experience interacting with ICD-10, CPT and HCPC codes and the relationships they hold to claim processing and insurance adjudication
  • Exposure or experience in revenue cycle processing from the point of intake through the point of a resolved account balance
  • Understanding of payer contracts, contract models and calculations based on contract language
  • Experience in a managed care role supporting operations working denied accounts, appeals, underpayments and/or zero payments in acute healthcare setting
  • Understanding of denials and 835 remittances and how it impacts the integrity of the patient account balance
  • Experience and operational understanding of contract performance and related workflows in Meditech, Athena, JDA, and Med-Metric preferred
  • Ability to communicate effectively with subject matter experts to ensure application usage and utilization meets needs of department
  • Ability to stay informed of regulatory and compliance related changes that impact claims processing and revenue cycle processing as a whole
  • Ability to keep up to date with industry financial and system related advances

• Support and collaborate with IT department as part of EPIC implementation to ensure the build of the payer contracts supports the needs of institutional and professional claims processing using EPIC best practice

   

• Coordinate and collaborate with billing, collections and managed care teams to confirm contract loads are producing anticipated results within applicable systems

   

• Maintain a relationship for support with any third-party vendor that may provide contract modeling services and support validation of modeling by coordinating with subject matter experts

   

• Participate in education, training and consistent feedback loops to applicable departments to ensure claim submission technicalities are communicated to clinical areas

   

• Stay up to date on claim submission requirements or changes based on government or regulatory programs initiated by payer(s)

   

• Generate necessary reporting, metrics and information needed for stakeholders related to operations of managed care contracting processes

   

• Complete and participate in projects related to new or closed service lines offered by the institution to serve as the subject matter expert when asked

   

• Other duties as assigned

Recognized as one of the 50 Top Cardiovascular Hospitals™ in the United States by IBM Watson Health™, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women’s health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the area’s only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks. For more information, visit halifaxhealth.org.

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