Revenue Cycle Business Analyst

The Opportunity

Working under the direction of the Senior Manager, the Revenue Cycle Business Analyst is responsible for the oversight of outsourced debit and credit accounts receivable, payment posting and related PFS tasks and projects. Additional outsourcing programs may be added in the future to help support the MGB RCO goals.

The Revenue Cycle Analyst will ensure provision of high-quality services by monitoring, triaging and reporting all issues and tasks related to the relationship management of our outsource vendors as well as drive results with any other key performance indicators. To achieve excellence in performance, this position will require the effective maintenance of a collaborative working relationship with MGB RCO staff. The Revenue Cycle Business Analyst must keep abreast of the rapidly changing technological and regulatory aspect of health care billing.

Keys to the success of this role requires working in collaboration with vendor management as well as CPBO, DHeC and MGB teams in reviewing and identifying ongoing workflow and operational deficiencies, as well as tracking and executing resolution on new or existing AR/denial trends in order to improve and enhance our vendor experience. The Revenue Cycle Analyst serves as an important link to inter-departmental initiatives and is responsible for developing, documenting, implementing, and monitoring policies and procedures related to its effective utilization by our vendor.

Principal Duties and Responsibilities:

The Revenue Cycle Business Analyst oversees or is involved with all the following functions/services in PFS, which include but are not limited to the following:

• Leads investigation and identification of workflow issues and trends.
  
• Drives issue identification and resolution by working with/from Tracking logs
  
• Responsible for maintaining, triaging and reporting denial trends/issues identified by vendor and/or internal staff via Issues Tracking logs
  
• Escalates issues based on experience and risk factors
  
• Responsible for ongoing review of WQs to validate/identify denial issues that may have otherwise not been reported
  
• Drives continuous improvement within outsource performance by working with vendor management and business stakeholders, closely monitoring Service Level Agreement metrics for discrepancies and/or deficiencies
  
• Proactively identify opportunities, challenges and trends by independently monitoring key performance indicators, and recommend improvements by working with Management
  
• Leads engagement discussions with appropriate internal management resources to provide guidance/insight/recommendations for tasks/AR projects/other workflows that can be considered for outsourcing
  
• Coordinates vendor staff onboarding tasks and requests
  
• Resolves inquiries from MGB RCO Management team related to improvement opportunities with vendor workflow protocols
  
• Leads QA validation audits related to new/revised WQ routing logic on completed Service Now requests
• Establishes and maintains new business checklists which are critical for onboarding success
• Analyzes and makes recommendations to correct challenges and/or breakdowns in operations and makes/coordinates changes, as required
• Assesses needs and implements policy and process improvement ensuring all staff members are aligned with roles, function and operating models
• Leads project-related meetings, including the creation of agendas, preparation of materials and distribution of minutes
• Develops and maintains working relationship across Revenue Cycle, Operations, and DHeC towards meeting the institutional goal of increasing revenue and decreasing denials
• Adhere to HIPAA guidelines
• Performs all other duties, assignments, and special projects as requested

Knowledge

• Utilizes electronic billing and medical retrieval systems as well as possesses in depth knowledge of medical billing and insurance rules and regulations to identify and speak to potential AR/denial trends
  
• Maintains a complete understanding of all vendor workflow protocols and operational procedures
  
• Possesses a solid understanding of Revenue Cycle management to include initial patient intake/registration workflows, medical coding principles, and billing and denial management concepts

General

• Maintains constructive, professional relations with internal departments and outside vendor to represent the MGB RCO effectively; professionally represents MGB RCO Patient Financial Services at meetings and projects external to the organization
• Achieves excellence in performance by working collaboratively with others on MGB RCO initiatives Supports and demonstrates the values of the MGB RCO Patient Financial Services by conducting activities ethically with integrity, honesty and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective with a willingness and enthusiasm to collaborate with others. Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes

Qualifications

• Bachelors degree or equivalent experience required
• Minimum of 5 years revenue cycle management or healthcare analytical experience.
• Demonstrated expertise working with Epic system required.
  
• Experience with professional and/or hospital billing and/or academic medical center preferred.
  
• Prior Management level experience preferred.

Skills/Abilities/Competencies:

• Exceptional organizational skills, and the flexibility to manage multiple tasks in a fast-paced environment.
  
• Demonstrated ability to juggle multiple projects/priorities to meet department goals and deliverables.
  
• Task-oriented individual with drive to complete and take responsibility for a variety of projects.
  
• Ability to effectively conduct meetings, both formal and informal.
• Ability to work both independently and/or within a team environment.
  
• Demonstrated ability to work effectively and courteously with various groups of staff and management
  
• Demonstrated ability to problem solve and function as a resource to other members of the MGB RCO to resolve complex issues.
  
• Proficiency with business software, i.e., Microsoft Office Suite (Word, Excel, PowerPoint); SharePoint experience a plus; knowledge of HIPAA Confidentiality and Privacy Policies is desirable.
  
• Knowledge of healthcare billing and Epic required.
  
• Must be well versed in Payer billing rules and requirements.
  
• Drives DE&I (Diversity, Equity, & Inclusion) and recognizes the value that different perspectives and cultures bring to an organization.
  
• Create and foster an atmosphere of continuous improvement.

Working Conditions:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This position is Remote but with the expectation that leaders will be asked to come into the office, on average, once per quarter for up to 4 business days (travel will be reimbursed per MGB policy).
  
• Hospital work environment working conditions include possible exposure to diseases or infections and may require safety gear (PPE) such as gloves and mask.
  
• Normal office working conditions. The noise level in the work environment is quiet to moderate.
  
• While performing the duties of this job, the employee is frequently required to sit; talk; or hear; use hands to finger; handle; or feel; reach with hands and arms. The employee is occasionally required to stand; walk; and stoop; kneel; or crouch. The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 20 pounds.
  
• Specific vision abilities required by this job include close vision, distance vision and depth perception.
  

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.