Option Care is a healthcare services company that at its core delivers high quality, cost effective infusion services through trusted partnerships across the healthcare system, resulting in outcomes that make a positive difference in people’s lives.
Job Description Summary:
The Senior Revenue Cycle Analyst is responsible for the internal audits performed within the Billing Center(s). The role is responsible for developing, implementing, tracking results, communicating and maintaining an effective and comprehensive revenue cycle audit program designed to assist in achieving the goals of Option Care consistent with Policies and Procedures as they pertain to the Intake and Reimbursement functions. In this role, collaboration among all Intake and Reimbursement teams is required to assure that the outcomes of the audits performed are communicated with all levels of the Revenue Cycle Team. Creates an action plan for improvement and provides recommendations to be reviewed by team leadership for areas of improvement via trend and root cause analysis. Responsible for training employees to improve output performance based on identified audit trends and serves as a first level of payer escalation and potential resolution. This position will facilitate cross functional communication between all appropriate parties (i.e. revenue cycle, operations, contracting, and other essential areas).
Job Responsibilities (listed in order of importance and/or time spent)
- Performs daily audits of Intake, Billing and Collections. Methodology for audits to be defined by Management Team
- Record all audit findings and adhere to a grading system for each audit to determine pass or fail grade based on a defined grading system
- Provide audit results to the Revenue Cycle Management Team on a weekly basis to be incorporated in a weekly scorecard
- Review all supporting documentation (delivery tickets, compounding sheets, contracts, etc) to assure that billing and collection activities adhere to company Policies and Procedures, Payer guidelines and Federal and State regulations
- Collaborate with Management Team to continually review and improve internal auditing and training program within the billing center
- Communicate any risk associated with audit findings to the Revenue Cycle Management Team
- Develop recommendations for standards or performance improvement based on audit trends and root cause
- analysis related to both internal and external audits
- Schedule weekly meetings with RCM’s and RCS’s to review audit results for their team members
- Schedule meetings as necessary with employees to review audit results and to train when appropriate based on audit results
- Apply learnings of audits to rest of business and reduce exposure to outside audits
- Act as next level of payer escalation, post Supervisor escalation. Work with appropriate team members to achieve final resolution or determine if further payer escalation is required
- Aide in the planning and scoping of initiatives within the department with input from the manager and supervisor
- Lead and oversee initiatives provided within the department
- Work with supervisors and managers to recommend changes in process or procedure to meet organization, and/or payer requirements or guidelines
- Expert on the process, best practices, and requirements for conducting audits and analysis of the intake, billing and collections process
- Work with other disciplines to develop processes that meet the needs of the Revenue Cycle Team and are cohesive in the process of the operations process, needs, and abilities
Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No
Basic Education and/or Experience Requirements
- Baccalaureate Degree required
- 2-3 years of analytical experience in the home infusion industry or comparable industry
- Strong, demonstrated knowledge of internal controls and best business practices
- Experience with Word, Excel and PowerPoint required.
- Excellent interpersonal, analytical and written/verbal communication skills required.
- High degree of integrity, trust and confidentiality required
- Ability to initiate work and fulfill responsibilities independently
- Ability to mentor revenue cycle staff and additional analysts
- Able to use enterprise analysis to define how the outcome affects the overall needs of the business
- Ability to adapt to and knowledge of multiple systems and analytics of multiple systems and changing IT infrastructure of the business. (PP, CH, IE, RP, Zirmed, Daytech, etc.)
- Has experience in the industry leading a variety of projects, with accuracy of requirements, and variety of projects and proven positive outcome
- Strong communication and analytical skills in a home infusion environment
Travel Requirements: (if required)
Up to 20%
Preferred Qualifications & Interests (PQIs)
- Demonstrated experience in project management and Revenue Cycle analytics desirable
- Familiarity with Medicaid, Medicare and Commercial Payer reimbursement requirements
- Understanding of iEmphsys and/or CPR+
- Understanding of overall Revenue Cycle Process: Intake & Reimbursement
This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.
Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.