Underpayments Analyst

We offer exceptional employment benefits including medical, dental, and vision plans, generous paid vacations and holidays, excellent retirement savings and investment plans, continuing education, and reduced fee and scholarship programs.

THIS IS NOT AN H1- B OPPORTUNITY

Responsibilities

The incumbent will be part of the Finance Division, Patient Revenue – Revenue Integrity & Health Information Management Enterprise Services team and responsible for enterprise-wide integrated applications deployment and maintenance. The Revenue Integrity Underpayments Analyst will enhance the current underpayment management process to reduce payment variance trends. Primary function to own payor-specific underpayment root cause analysis and workflow improvement response. A technical leader with a high degree of knowledge in the broad field and recognized expertise in specific areas; problem-solving frequently requires analysis of unique issues/problems without precedent and structure. Works with internal and external departments to formulate strategies, administer policies, processes, and resources, functions with a high degree of autonomy. Involves revenue cycle functions for the healthcare enterprise, including system billing, reporting, and support. Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services. Impacts processes to include authorization, registration, charge capture, coding, insurance identification, data entry, billing, contract management, payment posting, refund processing, and collections. Provides expert analysis and reporting of contract payer performance to include payment trends, denials, delinquencies, and payment variances from expected reimbursement; identification and tracking of issues related to underpayments to maximize revenue and increase efficiency, highly skilled in Epic Reporting Workbench, Clarity Reporting, and comprehensive AR reporting as well as monthly trend reports of manual write-offs. This position’s primary functions are analysis, system/process development, problem resolution, and workflow oversight. This position requires an expert level of operations and contract knowledge, a high level of independence and creativity, advanced analytical skills and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems in revenue cycle program areas, to identify weaknesses and develop innovative solutions and process improvements, sound judgment, as well as organizational and priority setting abilities. This position also serves as a backup for the department manager for operations and technical issues.

Required Qualifications

• Related degree preferred or equivalent combination of education and experience within a healthcare facility.
• Experience working with healthcare information systems
• Experience working with revenue cycle information systems or system implementation teams for complex projects, application development, or support
• Billing and accounts receivable experience analysis/management experience
• In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle. Ability to interpret a large volume of data and report it in a concise, meaningful manner.
• Knowledge of hospital billing and reimbursement procedures for Commercial/Managed Care and Government payers and the ability to recognize when policies are not being followed. Including experience with contracts pertaining to the division of financial responsibility and evaluating billing and reimbursement terms.
• In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
• Strong ability to advise management, serving as a technical expert, providing proposals for improvement and guidance on regulatory changes and industry trends and developments in revenue cycle management.
• Technical knowledge of all licensed health care service plans, including State and Federal plans, billing policies and procedures, and the ability to recognize when they are not being followed.
• Advanced organizational and project management skills and ability to lead a team, prioritize tasks, and see projects through from inception to completion on schedule. Ability to react with flexibility and patience and maintain efficiency and accuracy under sustained and immediate pressure created by a heavy workload, frequent interruptions, and multiple, sometimes competing, requests.
• Advanced communications skills can interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations to all levels of staff and management.
• Advanced skills in report development and various software tools specific to healthcare revenue cycle management. Skills in a common database, spreadsheet, and presentation software.
• Written skills to compose correspondence to parties outside the department and sufficiently communicate to other units within the department. Math skills to accurately add, subtract, multiply and divide.
• Develops and implements changes to systems, policies, and procedures to maintain currency in government regulations, reimbursement issues, and other matters having a potential financial impact.
• Demonstrates professionalism, tact, courtesy, and diplomacy in dealing with personnel at all levels outside the health system.
• In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle. Ability to review the work product of departmental employees and report findings.
• Ability to work accurately and quickly under pressure to meet deadlines set by the department, government programs, or private insurance carriers.
• Advanced interpersonal skills, with the ability to collaborate effectively on highly complex projects in a team environment with various business and clinical areas. Knowledge and skill in working with committees and user groups to facilitate group decision-making.
• Expert knowledge of and demonstrated skill with various spreadsheet and software applications including Microsoft excel and word, Clearinghouse, Contract Management, and Patient Accounting Systems.
• Ability to work cooperatively and constructively with employees and Administration.
• Ability to develop evaluation criteria for improving departmental activities/programs.
• Ability to develop reports or correspondence as required.
• Ability to use billing codes, including CPT, HCPCS, Revenue Codes & ICD-9/10.
• Reading skills to understand department policy and to read correspondence from within and outside the business office
• Knowledge of significant healthcare trends and issues that affect physicians, hospitals, and academic health centers.
• Knowledge of Epic billing system, fundamental functions, database structure, and reporting capabilities preferred.
• Knowledge of Huron reporting tools and reporting capabilities preferred.
• Knowledge of Health System methods, policies, and procedures.
• Typing skills sufficient to operate computer terminal, prepare correspondence for both within and outside the department.

Preferred Qualifications

• Academic institution or large integrated health system is preferred
• Experience working with interfaced/integrated multi-vendor applications preferred

Special Requirements

This position may be subject to a criminal background investigation, drug screen, Live Scan fingerprinting, medical evaluation clearance, and functional capacity assessment.

The University of California has implemented a SARS-CoV-2 (COVID-19) Vaccination Program SARS-CoV-2 Vaccination Policy (ucop.edu) covering all employees. To be compliant with the policy, employees must submit proof of vaccination or a University-approved exception or deferral.

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