Ambulatory Revenue Cycle Analyst

Job Description

Job Description

INTRODUCTION

Under the supervision of the Unity Health Care, Inc. (UHC) Applications Manager, the Ambulatory Revenue Cycle Analyst is responsible for in-depth knowledge of assigned Epic software application. He/she conducts regular day-to-day communication, reviews the software, demonstrates a deeper understanding of billing and claims operations, and works with Epic, the Project Team(s), UHC Revenue Cycle Representatives/Subject Matter Experts, and end users to tailor the system to fit the organization’s needs. The Ambulatory Revenue Cycle Analyst routinely performs in-depth analysis of workflows, data collection, report details, and other technical issues associated with the use of Epic revenue cycle system(s); is responsible for developing and documenting the internal procedures that will be used in conjunction with Epic applications; and will design, build, test, install and maintain those solutions. The Ambulatory Revenue Cycle Analyst is expected to use critical thinking skills in providing systems solutions to meet business needs and will play a key role in managing and optimizing billing processes and claims management within the Epic system for UHC to include analyzing billing data, resolving claims issues, and ensuring compliance with regulations to maximize revenue cycle efficiency. This role will leverage data analytics to drive strategic decisions, enhance operational efficiencies, and support revenue growth initiatives.

MAJOR DUTIES/ESSENTIAL FUNCTIONS

Essential and other important responsibilities and duties include, collaborates with ambulatory and operational leadership to strategically plan revenue cycle system development and coordinates with lead trainers to identify and address end user needs to achieve optimal system effectiveness and use, configuration of information, and supporting the assigned EPIC revenue cycle application(s). The analyst communicates with system end-users to understand issues and implement solutions. UHC requires that Epic certification be obtained within 180 days of hire. Required certifications must be maintained as assigned.

Cross Application Support

• Supports the following applications: Resolute Professional Billing, Resolute Professional Billing and Claims and Remittance.
• Understands the integration of Epic applications and their effects on business processes and operations.
• Stays abreast of functionality improvements in new versions and tests during upgrades; takes advantage of available resources to improve knowledge and understanding of the system.
• Adheres to IT change control process/governance, and ticket management processes.
• Independently leads Epic projects as assigned including providing appropriate documentation and status reports, delegating and making assignments for project tasks, and creating project timelines in collaboration with leadership.
• Performs system configuration and new project development, design implementation, workflow optimization, change management, and issue resolution related to the Clinic’s applications.
• Serves as the main subject matter expert for technical issues and general questions related to assigned revenue cycle applications.
• Triages requests and determines the priority of issues.
• Manages and tests new releases of assigned revenue cycle applications and applies. specialized knowledge and experience to ensure version upgrades functions smoothly.
• Resolves end‐user application issues using Epic documentation and ensuring business needs are met.
• Participates in disaster recovery measures.
• Ensures the test scripts have been created, reviewed, and updated to reflect proposed workflow solutions.
• Escalates end‐user problems to the appropriate level ﴾such as team lead﴿ when necessary.
• Validates solutions are complete and appropriately implemented.
• Champions and leads the project, providing support in ongoing implementations, optimizations, and upgrades.

Collaboration and Communication

• Understands Unity strategies and business objectives and collaborates closely with user departments to enable achievement using revenue cycle application functionality.
• Works closely with user teams to ensure seamless integration of revenue cycle processes.
• Communicates system changes, updates, and best practices to all stakeholders.
• Informs and implements IT change and communication management plans across assigned departments.
• Works in collaboration with Epic to implement new projects ﴾such as a new module﴿.
• Collaborates across revenue cycle operational teams to solve end‐user problems.
• Analyzes and communicates the impact of issues.

Process Improvement and System Optimization

• Develop and implements process improvements to streamline operations and enhance revenue cycle and revenue generation.
• Collaborates with IT and operational teams to optimize revenue cycle workflows and configurations.
• Participates in system upgrades, testing, and implementation of new revenue cycle features.

Quality Assurance

• Conducts regular audits and assessments of revenue cycle usage to ensure compliance with organizational policies and regulatory requirements.
• Identifies areas for improvement and recommends solutions.

Training and Education

• Collaborates with trainers to provide ongoing education and support to ensure effective use of the Epic system.
• Documents processes, workflows, and best practices for future reference and training.

Billing Analysis, Claims Management and Reporting

• Analyzes billing data to identify trends, discrepancies, and opportunities for process improvements.
• Ensures accurate and timely billing by validating charges and ensuring adherence to coding guidelines.
• Reviews and resolve denied or underpaid claims, coordinating with relevant departments to facilitate timely resolution.
• Prepares and submits claims to payers, ensuring compliance with all regulations and policies.
• Develop and maintain revenue forecasts based on historical data, market trends, and business insights.
• Generate and maintain reports on billing performance, claims denials, and revenue cycle metrics.

MINIMUM QUALIFICATIONS

• BA/BS in Finance, Business Administration, Health Information Management, or a related field.
• Two years of experience in healthcare billing, claims processing, or revenue cycle management.
• Experience in revenue cycle workflow and the enablement of process improvement using revenue cycle technology is preferred.
• Experience in a FQHC or similar community health environment is a plus.

REQUIRED KNOWLEDGE, SKILLS & EXPERIENCE

• Proficient understanding of healthcare billing regulations, coding (CPT, ICD-10, and HCPCS), medical billing and collection procedures to include Medicaid, Medicare private insurance, and self-pay.
• Strong analytical and problem-solving skills with attention to detail; ability to analyze data to identify trends and issues.
• Strong desktop tool usage including Word, Excel, and PowerPoint.
• Excellent oral and written communication skills and the ability to think critically and creatively.
• Must project a positive customer-oriented image to all system users, vendors, and management.
• Demonstrated skills in managing projects with the capacity to manage multiple competing priorities.
• Strong problem-solving skills to troubleshoot clinically related issues.
• Demonstrated flexibility with respect to changing end‐user business needs and priorities.
• Aptitude for learning new revenue cycle practice trends, software and systems.