Revenue Analyst - Biller/Coder - CV

Wentworth-Douglass Hospital-Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

Wentworth-Douglass Hospital remains among the nation's top hospitals for patient experience as a recipient of the Healthgrades 2022 Outstanding Patient Experience Award for the eighth consecutive year. Wentworth-Douglass Hospital is renowned as one of the largest acute care hospitals in the Seacoast region of New Hampshire and Southern Maine. At Wentworth-Douglass, we value people who contribute to patient-centered care that enhances community health; we recognize and reward those who share our values and transform our patients' lives. We invite you to explore opportunities, cultivate community wellness and professional growth.

JOB SUMMARY

Reporting to the Business Operations Manager, the Procedural Revenue Analyst will be responsible for ensuring all appropriate billing charges are being captured, reconciled and charged for procedural areas that may include the Operating Room, Anesthesia, Cardiac Cath Lab, Endoscopy Department and Center for Pain Management in accordance with policies and procedures, and applicable regulatory standards and requirements. Focuses on service-line charge reconciliation, billing processes and revenue analysis.

ESSENTIAL FUNCTIONS

1.Functions as the expert on charge capture and billing. Possesses in-depth knowledge of procedural billing; with the ability to acquire additional knowledge when new procedures are added.

a. Investigates the root cause of billing errors. Works with Revenue Management, Coding, Compliance and/or Managers to recommend and implement corrective action plan(s).

b. Leads efforts to identify new charge capture opportunities, while working closely with Revenue, Coding and the Charge Master team.

c. Stays abreast of routine developments in coding and billing regulations and legislation. Utilizes multiple resources to stay up-to-date such as the Federal Register, various Web sites (i.e. CMS.gov), and professional organizational meetings related to procedural billing.

d. Ensures all departments adhere to the Charge Capture and Reconciliation policy.

e. Works closely with procedural area managers on unresolved issues and identifying trends.

f. Completes special projects as required. May work on several projects simultaneously and/or lead project teams.

2.Ensures timely and accurate charge-capture for procedural areas.

. Reconciles charges against source documentation to ensure charges are complete and entered in timely manner. Identifies and corrects missing or inaccurate charges to ensure revenue integrity.

a. Responsible for addressing late charges and developing action plans, with the appropriate Manager, to decrease late charges.

b. Monitors compliance of charge entry and reports non-compliance to the appropriate manager.

c. Researches charge system problems and makes recommendations for resolution. Assists in the development of tools required to understand, monitor and improve charge capture efforts.

d. Provides training to staff responsible for billing data entry and related charge-capture activities to ensure procedures are understood and that charges are timely, appropriate, accurate, complete and properly documented.

e. Creates and implements education plans when charge capture education opportunities have been identified.

3.Acts as the primary coordinator and liaison to Revenue Cycle for procedural area charge description master.

Adheres to and ensures all departments adhere to the Charge Description Master Maintenance Policy FSPA-17.

a. Coordinates Annual CPT changes in accordance with the AMA and CMS.

b. Coordinates annual CDM and Charge Reconciliation sign off with Operations Manager.

c. Collaborates with Information Systems Analysts to ensure appropriates system updates are in place when new services are added/ inactivated or modified.

d. Maintains knowledge of changes in procedural billing reimbursement and billing requirements throughout the year.

4.Demonstrates advanced knowledge of computer systems and data analysis.

. Utilizes multiple computer systems to analyze and abstract data.

a. Creates and distributes reports related to charge entry, billing and/or revenue. Looks for trends in charge capture/billing discrepancies and reports findings to Business Operations Manager.

b. Assists in the coordination of data for projects.

c. Utilizes Microsoft Excel and PowerPoint at an expert level of proficiency.

Experience - Minimum Required

• 3-5 years experience in a hospital billing or revenue cycle department.

• Knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement.

• Knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance.

• Ability to recognize, research, and correct charging discrepancies.

• Knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority.

• Working knowledge of medical terminology and abbreviations, and health care nomenclature and systems.

• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.

• Ability to establish and maintain effective working relationships as required by the duties of the position

Experience Preferred/Desired

• Experience in procedural coding or billing.

Education Minimum Required

• Bachelor's Degree or equivalent experience in Business Administration or Healthcare Administration or related field

Training Preferred/Desired

• Certified coder, CHFP or RN.

Special Skills Minimum Required

• Strong Microsoft office skills.

• Experience with Soarian is highly desired.

• Ability to present to and interact with senior levels of hospital management.

• Excellent analytical, organizational, and project management skills.

• Strong time management, attention to detail, and follow through ability.

• A self starter who can function autonomously and with flexibility in a fast paced and ever changing environment.

• Must possess excellent oral and written communication skills.