Position Summary: We have an exciting opportunity to join our team as a Revenue Management Analyst-Process Improvement.
In this role, the Revenue Management Analyst will support the Revenue Management Department through the identification, quantification and execution of special projects identifying areas of increased net revenue opportunities. The analyst will provide reimbursement analysis, assists with bill problem resolution, and provide coverage guidelines for billable services to reduce or prevent future claim denials. This will be accomplished by reviewing current practices as they relate to system interfacing, account audits, contractual language, and any other system or department that may impact the financial health of this institution
Assists in conducting quality assurance reviews of rebill files and coding projects prior to processing.
Assists in conducting quality assurance reviews to assess accuracy of all Pricer functions to include accurate reimbursement calculation, & accurate charge posting.
Provides knowledge transfer, support to RMD staff.
Analyzes managed care contract language and make recommendations for increasing reimbursement.
Reviews Medicare and other third party payor communication / contracts to keep department abreast of billing requirements.
Analyzes business processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future cash losses and to optimize reimbursement.
Performs data collection, tracking and analytical duties to respond to key issues, increase reimbursement and process efficiency and in support of the decision making process of leadership from multidisciplinary perspectives.
Works collaboratively with Auditors to understand services provided, as well as Process Improvement Analyst to explore and capitalize on opportunities for increased reimbursement. Assist in identifying trends for process improvement projects with departments with the purpose of increasing overall net revenue and charge capture rates, and securing optimal efficiency.
Works independently, takes initiative, and thinks critically. Has the ability to function without supervision, completes assignments timely, requests feedback appropriately, and initiates inquiries to gain additional understanding.
Facilitates resolution of billing office requests for clinical charge audit or coding reviews. Ensures requests are addressed in a timely manner and oversees process from receipt of request to bill resolution.
Based on charge audit trends, identifies administrative errors, inaccurate service code assignment, and discrepancies in interpretation of charging and/or reimbursement methodologies.
Use audit results and trends to find opportunities for increasing appropriateness of CDM coding and charging methodologies. Based on contract language may make recommendations to maximize revenue capture/reimbursement.
Responds to staff queries regarding bill compilation and presentation and facilitates the charge creation process for new requests. Identifies appropriate revenue code(s) and accurate CPT and HCPCS Level II codes for any new services/items.
Assists with bill problem resolution and provides coverage guidelines for billable services.
Minimum Qualifications: To qualify you must have a Bachelor's Degree or equivalent in Economics/Statistics, Finance, Business Management, Finance, Healthcare administration or a related field. Three to five years of related health care administration/financial or revenue cycle analysis experience. Experience in financial analysis, budgeting, business and process analysis, working knowledge of third party reimbursement is required. Comprehensive understanding of audit and reimbursement systems, managed care contracts, rate structures, billing and collection processes and procedures, utilization review, health care information systems, outpatient revenue, home health, and other related health care topics is required.Strong analytical skills and excellent communication skills required.Knowledge of managed care terminologies and ability to interpret hospital bills, explanation of benefits, and medical records.Strong computer and systems application skills. Strong knowledge of NYULMC IT systems such i.e. Crystal Reports, Eagle, Horizon Surgical Manager (HSM) preferred. Experience in MS Access required
Preferred Qualifications: Knowledge of EPIC enterprise system preferred.Knowledge of coding guidelines, both ICD-9-CM and CPT-4 is preferred.Hospital Charge Master experience and/or billing or coding experience focused on the CDM is proffered
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.
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Internal Number: 62605677
About NYU Langone Health
NYU Langone Health, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.nyulangone.org.