Revenue Cycle Analyst

Basic Function: Under the general supervision of the Business Director administers and prepares management and billing reports to ensure timely and accurate billing of services for the division. Coordinates and manages special projects related to billing. Provides staff training on data input and Electronic Health Record (EHR); insurance, fee-for-service, and managed care processing for all divisional program units. Manages the accounts receivable function within the division.

Reports To: Business Director or designated Supervisor

Principal Duties/Responsibilities:

· Manages all fee-for-service, managed care, and insurance billings to commercial and governmental payors.

· Communicates and coordinates all avenues of revenue recovery.

· Acts as liaison between the BHCS programs and the payor to maintain clear channels of communication to ensure timely payments.

· Verifies patient prior approvals, duplicates and other billing irregularities prior to claim submission

· Identify and resolve any barriers for timely claim payments.

· Adjudicates and analyzes rejected billings and accounts receivable for collection to reduce billing error rates.

· Develops and updates billing procedures and guidelines, with appropriate documentation.

· Works on special projects to maximize revenue and best practice solutions.

· Ensures that all billings are in accordance with governmental rules and regulations.

· Participates in Agency and program billing meetings.

· Posts and tracks electronic and manual payments to accounts receivables.

· Assists in the preparation of budget analyses of programs.

· Recommends procedural changes and enhancements within the framework of overall policy guidelines.

· Maintain strictest confidentiality; adhere to all HIPAA (Health Insurance Portability and Accountability) and other industry rules and regulations

· Serves as the program’s primary billing and insurance resource person.

· Contributes to the development and structures of electronic billing and remittance processing systems.

· Conducts training on billing procedures and on the electronic health record (ehr).

· Represents the program were requested through direct involvement as it relates to electronic claims processing, adjudication and appeals.

· Prepare and present claim appeal documentation as part of revenue recovery where needed.

· Initiate and coordinate special projects designed to more accurately provide fiscal and financial reporting.

· Must have sound fiscal decision-making skills.

· Communicate to Management and Supervisors the practices and processes that will enhance clean claims processing and revenue, and those to mitigate lost revenue.

Salary Range: $40,000- $45,000

. This position calls for a minimum of a High School Diploma and Medicaid Billing Certification and 3 years of Medicaid claims billing and collections, or an associate’s degree in accounting or finance.

2 years of Medicaid claims billing and collection experience.

· The individual should possess a minimum of three to five years of insurance billing and collections in a healthcare fee-for-service environment. In addition, the position calls for some experience in fiscal reporting, working knowledge of Managed Care systems, familiarity with CPT/HCPC codes, and general healthcare terminology.

· This position requires the use of a personal auto, valid driver’s license and motor vehicle report acceptable to the agency’s broker and verification of insurance. This position also calls for an individual who has been cleared by the State of Illinois from disqualification based upon a prior history of child abuse/neglect. In addition, the individual must clear a personal background review, fingerprinting, and criminal checks.

· This position also calls for demonstrated competence in oral and written communication, ability to manage complex service units, the ability to effectively foster management cohesion and demonstrated proficiency in the use of PC hardware and software.