Decision Support Analyst
The Decision Support Analyst will analyze and audit the impact of reimbursement issues related to billing, charging, allowance and payments. Monitors and evaluates current payer reimbursement and payment rules and ensures that legislative and regulatory changes are anticipated and communicated. Position provides research and support compliance and/or revenue yielding opportunities that occur throughout the year. Responsible for all revenue cycle analytics, including month end revenue review and closing procedures. Participates in training and quality reviews of all revenue cycle departments to insure compliance with established federal and state regulations and organizational policies.
Primary Position Responsibilities:
- Works cross-functionally with RCM, Clinical, Accounting, Supply Chain, and Business Development personnel.
- Ensures all month end revenue related tasks are complete timely by assisting the Revenue Cycle manager and staff members.
- Works with corporate Finance to prepare consolidated month end cases analysis for all Arizona facilities.
- Prepares monthly physician and payer analysis.
- Prepares weekly and monthly utilization updates.
- Prepares weekly and monthly AR Analysis for leadership team
- Prepares monthly billing and charge entry analysis for leadership team.
- Prepares monthly denial and write-off analysis for leadership team.
- Tracks all case approvals and denials and reports results monthly
- Maintains case decision log by specialty and facility and disseminates weekly updates to all schedulers and business office personnel.
- Develops costing models for current and new procedure to determine feasibility by payer.
- Maintains database and tracks all payer contracts.
- Performs audits to test the validity of the payer contracted rate loads in patient accounting system along with testing claims to ensure accuracy
- Ensures that ambulatory surgery payments are correct and not systematically written off. Creates policy and procedures in order to maintain integrity of PFS
- Reviews and analyzes the allowance and payment transactions to ensure accuracy of usage and compliance with Managed Care contracts and staff
- Performs research to validate the accuracy of coding, charging and billing
- Creates and maintains Medicare, Medicaid, and Commercial timely case reports to ensure that claims are submitted in a timely manner
- Coordinates weekly billing review with billing department, corporate office, and local business offices.
- Prepares reports related to recommend changes business practices.
- Establishes and maintains effective communication with other healthcare providers, insurers, and patients/families to secure accurate and pertinent information to maximize reimbursement.
- Performs quality assurance evaluations to insure compliance with company policy, best practices, and established federal and state regulations.
- Uses good interpersonal skills to promote positive, effective interaction with customers/patients and to promote quality service to ensure flow of information to appropriate staff and professionals.
- Manages special projects as assigned.
- Other duties as assigned by a Supervisor The job holder must demonstrate competencies applicable to the job position.
Skills / Requirements
Total Education/Training/Vocational: Bachelor’s Degree in Business or equivalent experience of 3 years in related field. Preferred education: Master in Healthcare/Business Administration or equivalent Master’s level education. Minimum 3 years of increasingly responsible experience and technical expertise, including experience successfully managing various projects.
Skills and Abilities:
- Excellent analytical skills.
- Understanding of medical facility billing systems
- Understanding of ambulatory facility revenue cycle processes and practices
- Proficient in all MS Office applications
- Preferred experience in SQL and/or Oracle.
- Ability to direct and organize others to meet established goals.
- Flexibility, willingness to facilitate change and to take on other duties as assigned
- Possess basic knowledge of medical terminology.
- Possess knowledge of basic health insurance policies and practices
- Has the ability to communicate effectively with patients, physicians, families, co-workers, management and other Center employees.
- Ability to analyze large amounts of data effectively, efficiently, and accurately.
- Ability to speak clearly and concisely.
- Ability to read, understands, and follow oral, and written instruction.
- Ability to establish and maintain effective working relationships with employees, physicians, physician offices, and the public.
- Ability to handle multiple tasks in a busy environment and see them through to completion. 16. Excellent communication skills.
- Possess accurate judgment and decision-making skills.
- Possess strong initiative to get daily work finished and processed.
- Ability to set priorities and work independently.
Job Status: Full Time