Technical Analyst - Revenue Cycle and Claims
Description
Technical Analyst - Revenue Cycle and Claims
Job Summary:
- Works with stakeholders to discover, clarify, and document current and future data needs
- Performs mapping of revenue cycle, clinical and claims data to a normalized data model.
- Serves as a subject matter expert on the revenue cycle data domains such as Registration, Scheduling, Accounting and Billing, Cost Accounting and Claims
- Builds data concepts to support Revenue Cycle and Claims use cases
- Serves as a key resource for an assigned customer area to understand and explain business and technical issues and to provide viable technology solutions.
Responsibilities:
- Act as a quality consultant and subject matter expert, performing testing and validation of the mapping of data elements to standards
- Collaborates with technical resources to perform root cause analysis and complete remediation of data quality issues
- Works with customers to clarify and plan for their current and future technology needs. Determines and maps existing business processes/functions and recommends changes required to fit a tightly integrated system.
- Designs and implements projects requiring systems integration, small teams and multiple technical platforms.
- Conducts Return on Investment (ROI) and other financial analysis to support project funding/prioritization.
- Collaborates on driving improvement activities to achieve department and organizational goals.
- Coordinates with functional team to assure consistency and optimization of overall work product
- Assumes a proactive role in driving improvement activities to achieve department and organizational goals to deliver value.
- Maintains current knowledge of industry and business process trends and is able to apply that knowledge to existing business processes.
- Provides subject-matter expertise of Health Ministry processes, policies and requirements in support of functional area process design, testing and implementation
- Identifies opportunities for process improvement and makes recommendations that lead to improvements
- Monitors task assignments to ensure they are performed on schedule, within intended scope and to a defined level of quality.
- Escalates process and project issues that cannot be resolved
Experience:
- Prior experience working as a Revenue Cycle analyst in the Healthcare system.
- Must have a working knowledge of relational databases/database structures, SQL expertise desired
- Must have a strong understanding of data collected and used in EMRs, Revenue Cycle and Patient Accounting Systems.
- Knowledge and experience with ambulatory and acute clinical, billing and claims workflows and clinical information systems.
- Bachelor or Masters degree in related health or finance field ex informatics or bioinformatics.
- Complexity of work: Within the scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.
- 5 years of experience preferred