The Revenue Cycle Analyst plays a vital role in optimizing Mountainside’s revenue cycle operations by managing AR worklists, conducting audits, improving billing workflows, and supporting cross-functional financial initiatives. This position supports financial goals through accuracy, attention to detail, and a commitment to providing exceptional service.
Responsible for reviewing denied claims and carrying out the appeals process for Ingalls Memorial Hospital. Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence, and possibly setting up arbitration between parties. Maintains and monitors integrity of the claim development and submission process. Executes the denial appeals process in a timely manner.
Processes paper and electronic claims to payers with full and complete information to satisfy and facilitate the claim for payment. Produces accurate and timely claims in order to prevent denials and maximize reimbursement, by working assigned work queues within the patient accounting system and claim scrubber edits prior to final submission. Responsible for optimizing the claim submission operations including prospectively reviewing submissions and making corrections to expedite first time payment to the extent possible. He/ she is also responsible for research and communication of payer, HIPAA or other regulatory changes affecting the billing of health insurance claims and making recommendations regarding billing and system operations to improve payment turnaround. Makes recommendations regarding system changes to improve the revenue cycle process and quality, and works to assist in the development of training. Position requires high level of customer service skills to establish and enhance positive relationships with patients, colleagues, and others.
The Revenue Specialist – Veteran’s Administration acts as the liaison between key client contacts and the VA. This position handles patient health information (PHI) and maintains extreme privacy and security of confidential information. Responsibilities include analyzing VA claim payments, acquiring medical records, conducting follow-up with payers, and preparing initial bill packets or appeal letters.