Description

JOB SUMMARY

The Revenue Cycle Analyst will be responsible for all aspects of Revenue Cycle reporting. This individual will:

Distribute standard management reports as requested by end-users including but not limited to GoHealth Revenue Cycle leadership, Market Presidents, and the GoHealth Managed Care Contracting Department.

Design, develop, validate, and deliver new reports to meet ad-hoc requests for revenue cycle information.

Analyze payments received from third-party payers and identify variances between actual and expected payments.

Analyze third-party denials and prepare relevant reports regarding trends in denials. Determine root causes of denials. Work with the appropriate departments to establish processes to ensure prevention of the denials.

Review coding audits and identify missed opportunities to capture revenue. Prioritize identified opportunities based on the magnitude of the opportunity and develop strategies to capture lost revenue.

Obtain, manipulate and analyze data from a variety of sources including but not limited to: physician billing systems, external contract management systems, external claims systems, and an internal data warehouse.

JOB REQUIREMENTS

Education

Bachelor’s Degree in Finance, Accounting, Business Intelligence or relevant field required

Work Experience
 3-5 years of medical billing experience (EPIC or eCW)
 3-5 years of experience in financial analysis or business intelligence
 3-5 years of experience in payor contracting preferred
 3-5 years experience developing and implementing enterprise-scale reports and dashboards preferred

Required Licenses/Certifications

Business Intelligence certifications preferred
Epic Revenue Integrity, Physician Billing Certification or Hospital Billing Certification, preferred

Additional Knowledge, Skills and Abilities Required

• Understanding of data integration issues (validation and cleaning), familiarity with complex data and structures
• Excellent interpersonal (verbal and written) communication skills are required to support working in project environments that includes internal, external and customer teams
• Strong analytical skills and intuition, capable of making decisions based on analysis and experience
• Experience ensuring data integrity and accuracy through quality control techniques
• Ability to work both in a team and independently when required
• Ability to communicate clearly and often regarding project progress, challenges, and/or issues
• Ability to manage multiple priorities, and assess and adjust quickly to changing priorities
• Programming / scripting experience would be a plus 

Additional Knowledge, Skills, and Abilities Preferred

•  Experience with the managed care contract reimbursement process
•  BIME, SQL, Domo, Lean Six Sigma training

ESSENTIAL FUNCTIONS

• Create and maintain KPI dashboards for revenue cycle functional lanes to be updated on regular cadence but no less than monthly
• Variance reporting for RC Leadership team including insights and potential root cause analysis
• Work closely with Managed Care Contracting to ensure accurate set up of contract terms 
• Review reimbursement and variance reports from Epic and eCW 
• Assist in preparation of reports to share with payers when discrepancies in reimbursement are uncovered  
• Review and analyze reports to ensure timely receipt of payments from managed care contracted partners per terms of contracts
• Establish audit trails for investigation of adjustments, refunds, write-offs and collection efforts by internal and external audit firms
• Preparation of payer scorecards to share with Managed Care Contract partners for use during contract renegotiations and quarterly business reviews
• Develop and maintain denial reports to use for root cause analysis
• Prepare reports or presentations to share the results of denial analysis with affected areas
• Research, identify and analyze the impact of potential process changes after completion of root cause analysis of denials
• Conduct claims analysis to verify charge master compliance and identify revenue improvements
• Prepare and conduct educational services to departments and staff pursuant to audit findings, regulatory changes and requirements, and managed care billing requirements

All other duties as assigned.

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.