Lead Revenue Cycle Analyst

Rochester, NY

POSITION SUMMARY:

Coordinates elements of project activity, schedules and identifies required resources to meet project objectives. Maintains high level of communication with department supervision and management to achieve goals. Leads processes ensuring that Revenue Integrity’s role meets Hospital and UBO goals and KPIs (key performance indicators/metrics) in most efficient, cost effective, appropriate, and compliant manner. Evaluates charge capture, charge entry, charge review resolution process for the hospital(s) in conjunction with the SMH/HH hospital revenue integrity Facilitators and Director of Revenue Integrity. Develop Plan of Action, coordinate with IT, Departments, test design and execute procedure changes to improve departmental operations and increase revenue, reduce costs. This position’s responsibility encompasses managing revenue integrity analytics; charge capture/reconciliation, Provider Based Billing (PBB), charging of URMC services throughout the entirety of the medical center (all UR Medicine locations HB and PB– inpatient and outpatient, long term care, hospital clinics, office, etc.). Oversight of setting hospital prices for all services at SMH/HH, working with payer contracting to ensure accurate pricing with supportable pricing methodology. Tracks all pricing changes, monitors CDM for errors and maintains a detailed pricing manual. Ad hoc special assignments as requested by leadership.

DUTIES AND RESPONSIBILITIES:

Under general direction with considerable latitude of independent judgment, initiative, and discretion, recognizing that Revenue Integrity is vital to ensure the continued financial viability of the University of Rochester Medical Center.

PRINCIPAL DUTIES & RESPONSIBILITIES

(35%) Management, Finance/Analysis

  • Supervision and Direction Exercised: Oversee staff and manages personnel-related matters, such as interviewing, hiring, training, time reporting, development, engagement, performance evaluations, attendance and the corrective action and disciplinary process. Assures compliance with FLSA and interprets University policy for staff. Holds staff meetings.

  • Oversees daily and trending charge capture data for all URMC hospital related business (professional and technical hospital charges). Facilitates recommendations to SMH Leadership, MFG/SMH/HH Leadership, Revenue Cycle Managers, and Finance based on data driven findings.

  • Researches, develops, implements, and trains staff on the use of Epic Resolute and non-Epic applications to maximize revenue and increase operational efficiencies for charge capture and revenue. Monitor and report on key performance indicators (KPIs) to leadership. Engage with clinical leaders, program administrators, clinical chiefs and chairs to ensure KPIs are met and recommendations for process improvement and education needs. Collaborate with clinical leaders, program administrators, clinical chiefs and chairs to ensure charge capture and documentation standards are in place.

  • Provides oversight and ongoing assessment of analysts working with departments in conjunction with Director of Revenue Integrity. Develop guidebooks, policies, and procedures.

(35%) Regulatory, Pricing

  • Keep up to date of rapidly changing technological and regulatory aspect related to CPTs, compliance, charge capture and the electronic medical record, and provide guidance in these areas to Revenue Integrity leadership, URMC finance and billing office leadership and staff.

  • Maintain an open line of communication and close partnership with EPIC builders (ISD) to ensure accurate, timely updates to the CDM.

  • Directs overall pricing strategy for SMH/HH and provides additional guidance to regional affiliated hospitals. Collaborates with payer contracting and ISD to produce accurate data to meet price transparency guidelines and deadlines.

  • Oversees annual price increase, maintaining pricing consistency between hospitals as well as HB and PB Chargemaster. Responsible for the development and maintenance of the price/charge auditing process.

  • Contacts outside resources (vendors, consultants, equivalent positions in other colleges or universities, etc.) to exchange or gather pertinent information related to ongoing projects.

  • Assist in identifying gaps in EPIC reporting and mapping through interaction with ISD. Identifying gaps in current processes and potential build issues.

  • Develops charge baselines by department and charge code. Directs staff analysts in maintaining and updating baselines.

  • Develops and maintains dashboards for revenue integrity for distribution to senior leadership and department administrators.

  • Collaborates with Patient Financial Services on revenue cycle initiatives including but not limited to reducing charging delays/errors, establishing charges for new hospital programs, and improving revenue collection.

(30%) Process Improvement

  • Investigates technologies to improve operational efficiencies and implements new procedures to enhance efficiencies. These include but are not limited to Charge Review edit reports, analysis of EPIC and other application reports, epic charge router and department specific workflows. Using additional reporting tools for regular price audit and to guide data driven decisions.

  • Takes leadership on assigned and unassigned projects with latitude for independent judgment which involves researching, analyzing, planning and implementation and or education.

  • Participates in systems design activity to assure the system design and departmental operating procedures are synchronized, and to assure client offices and systems designers fully understand system data flow and the requirements to maintain data integrity.

  • Assists in the implementation of major systems changes, including departmental procedural changes.

  • Provide input and guidance in developing standard HB and PB KPIs, enterprise-wide reporting and baselines used for EPIC go live and ongoing monitoring. Implement and administer reporting structure of analyst and charging information for URMC.

  • Consults with management and supervisory personnel in clinical and billing departments to carry out analyses of procedures and work, and in the implementation of approved recommendations.

REQUIREMENTS:

  • Bachelor degree in Health Information Management, Healthcare Administration, Business, or related field, with 5 years related work experience including management level experience.

  • High level knowledge and experience with CPT/HCPCS.

  • Requires demonstrated leadership abilities, highly organized, excellent communication skills, analytic and presentation skills.

  • Highly experienced in Excel, Pivot Tables and Power point, SQL queries, and Microsoft outlook suite.

  • Flexible and adaptable, ability to work with ambiguity and in a changing/evolving environment.

  • Continuous learner, self-guided.

  • Strong teamwork/collaboration.

  • Master’s degree preferred.

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $75,650 - $113,464 Annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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