RCM Analyst

Oversees the integrity of the Charge Description Master (CDM) and maintains responsibility for updates to charge codes within the CDM. The Analyst monitors quality and key metrics to ensure all activities are being completed by the CDM team in a timely and accurate manner. Oversees daily maintenance, regular updates, and price impact analyses and facilitates all changes implemented in the CDM. Works closely with the Revenue Cycle Management Team to ensure accurate and timely charging, recommend process improvements, and maximize gross revenue.This role would be designing, building and supporting Patient Access Solutions for registration, scheduling, revenue cycle management, and the patient portal.

• Oversee processing of CDM requests to ensure that all additions, changes, and deletions are consistent with proper charging, billing, coding, and pricing practices in a timely manner.
• Facilitate analysis of the CDM to ensure accurate assignment of CPT and revenue codes to the Charge Master to comply with regulatory practices.
• Provide assistance and analysis to all levels of clinical management in support of suggested, requested and/or mandated changes to the CDM.
• Manage, prepare and review monthly reporting metrics for internal and external stakeholders
• Identifies issues and conducts analysis and/or audits (i.e., gap analysis, audit summary) of payer and/or client issues and escalations.
• Manage and oversee payer and patient revenue cycle management processes for various hospital specialty accounts
• Conducts trending on baseline metrics (billing, collection, and remittance) and assist with the development and resolution of action plans

• Analyze insurance denial trends and create front end edits/rules to help increase clean claim rates and reduce denial rates.
• Create and track payer project plans associated with accounts receivable, including communication with payer representatives to initiate claims projects.
• Maintain archive of process, policy, and training documents.
• Monitor and document payer updates to enhance the billing system or enhance scrubs/edits and reduce denials
• Provide weekly status reports on projects to the Manager - RCM.
• Respond to Customer Care Center questions and cases and/or escalate as needed.
• Perform audits to identify opportunities to drive improvement
• Manage multiple tasks and deadlines with minimal oversight
• Participate in strategic planning sessions
• Perform any manual or specialized billing needs as required

• Proficient in all Microsoft Office applications as well as medical office software.

• Proven experience in healthcare billing.

• Sound knowledge of health insurance providers.

• Deep knowledge of Revenue Cycle Management within Billing, Collections, and Remittance posting.

• The ability to work in a fast-paced environment.

• Billing/Coding certification(s) preferred but not required

• Knowledge of payer websites, processes, local, state, and federal requirement

• ERP knowledge preferably SAP functional skills are a requirement to be successful in this role.

Minimum 6 years of experience in Healthcare (required)

Minimum 2 years’ experience with data analytics (required)

Minimum 2 years in GCC (preferred)