Position Goal

The Revenue Cycle Analyst is tasked with reviewing and ensuring timely follow-up on claims for resolution across all payers for the facility. Additionally, this role involves examining claims errors for both electronic and paper remittances and requesting corrected billings from all payers. The analyst will carry out follow-up activities throughout the entire claims adjudication process.

Position Responsibilities

• Monitor and resolve outstanding accounts receivable balances in a timely manner preventing AR aging as follows: 31-60 <=15%, 61-90 <=8%, over 90 <=12% by employing effective collection techniques, maximizing efficiency and cash collections.
• Responsible for working on all denials via MedEvolve Denial Management system and updating the status per parameters set.
• Responsible for reporting billing, registration, posting errors/issues to the Director.
• Review audit trail reports received from all payers, identifies and corrects rejected claims and resubmits to payers.
• Recommend front-end edits to be put in the electronic billing software.
• Monitor, review and/or respond to correspondence within 48 hours of receipt.
• Update the patient account to reflect the current billing status with clear, detailed notes.
• Determine payment status on patient accounts using online claim status tools, voice/fax systems or via direct telephone inquiry to representatives with multiple insurance companies.
• Rejection resolution by preparation of appeal documents when claims are denied including securing medical records, preparing letters of appeal and sending needed information/documentation and/or corrections.
• Work AR and credit balance report weekly as well as maintain various reports.
• Identify on explanation of benefits (EOB) that claim has been paid correctly, posted correctly and patient financial responsibility has been appropriately transferred in the system.
• Prepare detailed recommendations for adjustment to be made on accounts based on research and interpretation of activity on accounts.
• Report any errors/issues to management while monitoring compliance with payer contracts and federal/state guidelines.
• Must maintain knowledge of payer contracts to work in AR accurately.
• Actively assist and engage in other areas of the Business Office as needed in order to achieve departmental goals.
• Meet assigned productivity of 95% or higher and quality assurance goals of 2.8 or higher.
• Demonstrate superior prioritization, organizational, and time management skills while consistently maintaining current AR balances and reducing aging accounts receivable balances over 30 days

Position Requirements

Experience:

Required:

• Good math skills and proficiency in Microsoft Applications to include Word, Excel and PowerPoint.

Preferred:

• Relevant previous billing or insurance collections experience.
• Two (2) to four (4) years of experience in health care.

Education:

Required:

• High School Diploma or equivalent.

Special Qualifications:

Required:

• None.

Preferred:

• Certified Patient Accounts Representative (CPAR) or Certified Revenue Cycle Representative (CRCR).

All applicants must apply at www.hughston.com to be considered

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.