Reporting to the Income Integrity Supervisor, the Income Cycle Analyst performs a significant function in supporting each medical and pharmacy income operations by analyzing billing efficiency, monitoring KPIs, figuring out tendencies in payer habits, and producing actionable insights that drive operational enhancements.
Consultant Duties:
Income Cycle Evaluation
- Monitor key income cycle metrics together with AR days, clear declare price, denial price, fee lag, and web assortment price.
- Monitor payer combine, reimbursement tendencies, and denial volumes to establish systemic points or inefficiencies.
- Consider tendencies in medical and pharmacy billing and proactively suggest options to extend collections and scale back fee delays.
- Develop actionable insights and techniques to help income cycle enhancements throughout departments.
- Help the creation of appeals, workflows, and edits based mostly on recurring denials or underpayments.
Knowledge Reporting & Visualization
- Construct and keep real-time dashboards utilizing instruments like Energy BI, Tableau, and Epic Reporting Workbench.
- Generate month-to-month, quarterly, and advert hoc studies to information management decision-making.
- Current root trigger analyses and monetary tendencies in concise, visible codecs tailor-made to different stakeholders.
- Establish key drivers of variance in anticipated vs. precise reimbursements and contribute to forecasting fashions.
Strategic Planning & Optimization
- Analyze operational bottlenecks in cost entry, coding, declare submission, and denial workflows.
- Mannequin efficiency outcomes and conduct what-if analyses to venture monetary impression of course of modifications.
- Present perception into payer-specific behaviors and reimbursement insurance policies that impression money movement and AR getting older.
- Take part in payer conferences and income cycle vendor check-ins to signify knowledge findings and accountability measures.
Programs and Compliance Oversight
- Make the most of Epic EHR and pharmacy billing platforms (e.g., ComputerRx) to extract, validate, and analyze billing knowledge.
- Guarantee compliance with billing requirements, HIPAA rules, and payer-specific necessities.
- Contribute to chargemaster opinions and documentation audits with perception into income impression.
Performs different associated duties as required
- Means to work harmoniously and successfully with colleagues, sufferers, purchasers and distributors throughout the spectrum of variety, together with however not restricted to race, ethnicity, colour, gender id, sexual orientation, age, socio-economic standing, nationwide origin and immigrant standing, non secular or religious id, incapacity (bodily, psychological, emotional and developmental), veteran standing, and/or restricted English proficiency.
- Willingness to contribute in direction of Fenway’s efforts in turning into an anti-racist group and selling a tradition devoted to ongoing improvement in service of humility, fairness, variety, inclusion, and belonging, the place variations are acknowledged and valued.
- 1–3 years of expertise in income cycle analytics, income integrity, or healthcare billing and reporting roles.
- Fingers-on expertise with Epic (ideally Readability or Reporting Workbench) and pharmacy billing techniques.
- Familiarity with healthcare billing requirements (i.e., CPT, HCPCS, ICD-10), payer reimbursement methodologies, denial administration, and claims processing in both ambulatory, pharmacy, or FQHC settings.
Most popular {Qualifications}:
- Affiliate diploma in Enterprise, Healthcare Administration, Informatics, Finance, or associated discipline.
- Licensed Income Cycle Consultant (CRCR) or equal income cycle certification.
- Understanding of FQHC-specific income cycle nuances and value-based care reimbursement.
- Wizard degree Excel abilities
Bodily Necessities:
Means to satisfy the next bodily necessities with or with out affordable lodging:
- Sit at a pc station for prolonged durations of time
- Means to be on a keyboard for prolonged durations of time
This can be a union place in a Fenway Well being bargaining unit represented by 1199 SEIU United Healthcare Employees East.We provide aggressive salaries, and for many who qualify, a wonderful advantages package deal; together with complete medical and dental insurance policy, beneficiant paid day off, commuter advantages, and extra.LGBTQIA+ recognized individuals, Black, Indigenous, and different folks of colour (BIPOC), and people from different traditionally underrepresented communities are strongly inspired to use.