RCM Analyst

Job Title: RCM Analyst

Location: One GI Corporate (Work From Home Eligible)

Reports To: VP, Revenue Cycle Management

Job Summary: Manages the employees, strategy, and direction of One GI’s RCM Analyst function across multiple states and practices. This position will perform analysis in all RCM functional areas. Assist in departmental education on these functions, and the identification and assist in implementation of process improvement opportunities, in collaboration with Revenue Cycle departments, in order to enhance revenue potential. This role interfaces with regional and corporate leadership, department leadership and associates on a regular basis.

Key Responsibilities:

• Develop and maintain standards to measure the effectiveness of all aspects of the revenue cycle, including statistical data for monthly reports (denial reports, late charge reports)
• Keeps apprised of rules and regulations affecting reimbursement and revenue cycle.
• Participates in implementations, planning, and training for acquisitions, new services, programs, payers.
• Assist in the development of training programs for departments to increase knowledge of relationship between gGastro, charges, billing, and reimbursement.
• Identify revenue cycle problems, research/analyze data to resolve issues, identify & select alternatives to address outstanding issues, and work with
• Review physician charge patterns by procedure, diagnosis, denial, insurance type and other insurance groupings as identified.

General

• Adopt the One GI culture of respect, integrity and accountability that contribute to an internal environment of teamwork and promote a positive brand image to our external customers.
• Incorporate a leadership mindset to your role.
• Comply with One GI procedures, policies, and regulations relevant to your role.
• Successfully completes all One GI training requirements (i.e. OSHA, HIPAA, HealthStream, compliance, etc.)
• Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws.
• Computer skills good working knowledge of MS office.
• Ability to communicate effectively with others, both verbally and in writing.
• Proven ability to manage time, meet deadlines and prioritize.
• Able to maintain standards and professionalism during periods of fluctuating workloads.
• Provide professional service to direct customers of One GI in all interactions.
• Build effective working relationships with other team members.
• Manage daily tasks to ensure business needs are consistently met.

Education and Qualifications

• High School Diploma or equivalent required.
• Bachelor’s degree in business administration, Finance, or Health Administration or equivalent experience required.
• Master’s degree preferred.
• Advanced knowledge of healthcare insurance benefits, prior authorization guidelines for commercial and managed government insurance carriers, good faith estimates, point of service collections, and appeals required.
• Advanced understanding of compliance guidelines required.
• Advanced knowledge of healthcare reimbursement methodologies required.
• Advanced knowledge of the provider-based operations related to the revenue cycle required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to speak and hear. Understand/comprehend English as well as read/follow written English instructions.

Work Environment

This is largely a sedentary role.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Accommodations

Reasonable accommodations will be made to enable a qualified individual with a disability to perform the non-essential or essential functions of this job. All accommodations will be investigated on an individual basis with the needs of the department and current staff resources considered. Accommodations will not be made that compromise the safety and health of any associate.