The RCM Business Analyst will perform all data entry, process and reconcile month end close. Manages changes in EPM system (NextGen) including charge master tables, contracting module, CPT/ ICD-10 updates. In addition the following accounting level functions rate setting, cost report preparation and PPS Reconciliation. Serve as RCM technical resource for projects and system interface requirements, specifications, and implementations. Responsible for developing and completing all revenue cycle management staff training on NextGen EPM and all other systems/databases used to perform billing and collections.
Positions Responsibilities:
The following are essential job accountabilities.
1. Performs end of month close, financial analysis/ (KPI), and reporting. Completes and distributes all department specific reports, productivity measures, clinic & RCM performance dashboards.
2. Maintain the charge master and other revenue cycle related databases to perform productivity analysis and financial reporting.
3. Maintains data integrity within RCM by performing all system edits, additions, monthly / annual maintenance. Acts as an internal consultant to RCM team and performs ad-hoc analyses along with recommendations for improvements based on data interpretation from EPM (NextGen) and/or any other system database relating to revenue cycle.
4. Support the annual preparation of PPS reconciliation working with internal and external consultants and accounting staff members to provide a complete reconciliation of PPS reimbursement.
5. Prepare rate setting paperwork for all new sites acquired to OFH including preparing the cost report and other duties as assigned in the completion of new site rates.
6. Completes and distributes RCM and Health Center specific productivity measures and reports to support the monthly dashboards. Prepares and presents informational and educational information to RCM leadership (contractual allowances, Capitation utilization, etc.). Collaborates with Information Technology to automate processes related to the EPM & EHR including data extraction to outside vendors and internal system automation.
7. Performs data mining and abstracting of financial information from various support tools for operating budget, planning, revenue and reimbursement analysis and other revenue related decisions as requested.
8. Various other work-related duties as assigned by supervisor and/or CFO. These duties and
responsibilities may be added, deleted, or changed at any time at the discretion of management,
formally or informally either verbally or in writing.
9. Supports the creation of department specific standard operating procedures (SOP) training tools, creates EPM (NextGen) and other systems training materials, research and make
recommendations for technology based learning solutions to support the revenue cycle process.
10. Supports the revenue cycle process by acting as a liaison to research billing issues between the various OFH departments, finance and RCM.
Additional Duties:
1. HIPAA compliance – Responsible for enforcing compliance with all HIPAA regulations and
requirements. Treats patient/client information confidential.
2. Compliance – Ensure compliance with all local, state, and federal regulations.
3. QA/QI – Participate in QA/QI activities and contribute towards the overall performance
improvement of the organization.
4. IT – Required to learn and use the Electronic Health Record and Practice Electronic System and
its components as required by the job functions and highlighted in the Policies and Procedures.
5. Will participate in Patient Centered Home Health Model at Omni Family Health.
Job Requirements
1. Ability to work under pressure and handle multiple tasks & functions.
2. Knowledge of community based organizations.
3. Ability to communicate with medical/dental & mid-level providers and staff.
4. Knowledge of CDT, CPT and ICD10 codes.
5. Promotes and supports OMNI’s mission statement.
6. Ability to work proficiently and effectively within a timely manner.
7. Knowledge of account receivable processes, payer codes, and other record keeping functions.
8. Knowledge of clinical terminology and billing practices.
9. Ability to operate computers, Microsoft operating system and provide direction to staff as
needed.
10. Must be able to take responsibility and work under pressure.
Qualifications, Education, and Experience
Education:
High school graduate or equivalent required.
Associate or bachelor’s degree/certification or higher preferred
CPA preferred but not required
