Under the supervision of the Revenue Cycle Director, the Revenue Cycle Analyst is responsible for providing strong analytical assessments, reporting, and operational support on multiple aspects of revenue cycle operations in a central business office. This position will primarily support revenue cycle operations for Columbia's College of Dentistry and Ambulatory Teaching Clinics.
Reviews and analyze "Explanation of Benefits" (EOBs), payer correspondences to identify denials to be appealed. Perform denials analysis to reduce controllable rejections.
Perform data extraction and manipulation using BI tools, Excel, and other query tools within practice management systems.
Utilize knowledge of group payer contracts, payer policies, payer plans, and member benefits to perform reimbursement analysis.
Apply knowledge of professional billing, payer policies, medical coding, and key contractual terms in performing analysis. Relay changes in insurance policies discovered by claim denials to all pertinent stakeholders.
Participate in training and other in-servicing sessions for end-user education within the central business office and service vendor.
Facilitate and work payer projects to manage bulk appeals with various stakeholders and insurance carriers.
Oversees various projects as directed by the Director. Operationalizes project plan including developing and executing related communication plans. Tracking project plan progress, proactively identifying areas of resistance, and outliers to escalate for mitigation, executing mitigation plans as needed. Preparing presentations for various sponsors and stakeholders as needed.
Monitor and perform analysis on work queue inventory to identify corrective actions to work queue logic including, but not limited to, review logic criteria and ensure correct logic build, obtain feedback from work queue users to understand trends and workarounds, make recommendations to improve logic build and reduce outliers and/or backlogs.
Develop new report templates for ad-hoc and or standard monthly reports to assist with monitoring of Revenue Cycle Metrics. Provides assessment of revenue cycle processes with a focus on process improvement and best practice. Monitor and analyze to compare with industry benchmarks.
Prepares reports and formal presentations for leadership
Assist with management of user access to various systems such as payer portals, EMR, receivables system, and bank lockboxes
Assist management with obtaining pertinent data to support establishing and maintaining service agreements with external vendors. Facilitates auditing and processing of vendor invoices for payment.
Assists with performance tracking of external vendor services. Assist with identifying and resolving operational issues with the deliverance of services by vendors.
Assist unit management with a compilation of staff productivity and quality assurance statistics. Assist management by analyzing productivity and operational performance of business units through the use of key metrics and pertinent data.
Assist Director with identifying relevant trends and opportunities. Analyze trends and key data points to maximize efficiencies with in and outbound collection efforts. Identify opportunities for creating estimates and pre-payment collection effort
Present data, analysis, and recommendations for solutions in meetings with unit management and other stakeholders.
Effective collaborative relationships with peers and other subject matter experts (SME) to seek resolution of issues identified through monthly monitoring of KOIs/KPIs.
Represents the CRO Management Team on committees, task forces, and workgroups. Negotiates workable compromise solutions to complex problems between the FPO, CRO, and other departments, outside vendors, etc.
Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.
Performs other duties and responsibilities as assigned by the Chief Revenue Cycle Office and Directors of the CRO.
Bachelor's degree or equivalent in education and experience.
4 years of related experience with a preference for experience in physician billing and third-party payer reimbursement.
Advanced skills in using excel and BI data applications to maneuver through large volumes of data.
Strong verbal and written communication skills.
Ability to work independently and follow-through and handle multiple tasks simultaneously.
Must be a motivated individual with a positive and exceptional work ethic.
Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government, and self-pay reimbursement concepts and overall operational impact.
Strong knowledge of electronic billing systems for front end and back end functions and the willingness to learn new systems, applications, and programs.
Advanced proficiency in data extractions (DBMS & Data Warehouse Tools) and use of business analytic applications.
Demonstrated advanced skills in A/R management, problem assessment, and resolution, and collaborative problem-solving in complex, interdisciplinary settings. Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution.
Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
Experience with GE/IDX, EPIC, Experian, and Cognos is preferred.
Equal Opportunity Employer / Disability / Veteran
Columbia University is committed to the hiring of qualified local residents.
Internal Number: 510651
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