Practice Optimization Analyst

Essential Job Requirements

Clear understanding of the revenue cycle components in a physician practice. Ability to perform critical thinking analysis understanding the upstream and downstream connections of front-end physician practice KPIs. Proficiency in reviewing, analyzing, and completing any assigned task. Proficiency with technology and ability to learn new EHR platforms and their workflow processes. Practice Operations Analyst have a positive impact on the financial health of our clients while providing excellent customer service. Independent thinker with the ability to think thru and identify best practice opportunities. Ability to meet all productivity goals as assigned. Ability to hold themselves accountable to front-end performance while not performing the work. Ability to solve complex problems and provide documented solutions and recommendations to clients. Ability to learn and complete multiple task and shift between task as required.

Touchpoint

Practice leadership Practice associates Department leadership

Breakdown Of Responsibilities (Weekly/Monthly)

Department support: 100%

Complete Assigned task: 70%

Consistently meet Productivity Measures for given work Registration/ eligibility Editing/correcting/ submitting registration errors Correct claim edits Enter charges Edit/correct and submit front end denials Work assigned workqueues or claims when required

Monitor, Review and Analyze Client Data: 10%

Reviewing Analytics data Reviewing and analyzing EHR dashboards and data Root Cause Analysis of Data Abnormalities Preparing recommendations based on data Issue Resolution and recommendation

Administrative: 10%

Client Correspondence Weekly Report outs Team Meetings

Personal Development: 5%

1:1’s with manager Course work Educational sessions Training

Other Duties as assigned: 5%

Leadership

Expectations of this position are as follows:

• Able to adjust quickly and seamlessly to abrupt change.
• Able to adapt and create multiple solutions to complex problems
• Able to present information effectively to associates as well as leadership.
• Able to learn and adapt to different technology
• Fluent and proficient in Microsoft Office products
• Must have good written as well as verbal communication skills
• Able to quickly learn procedures and processes assigned to them.
• Responsible for the KPI’s associated to assigned task
• Partners with practice operations and leadership to improve front end revenue cycle metrics affected by clinic workflows, processes and habits, as well as working to establish best practices and efficiencies
• Completes other duties as assigned.
• Consistently adheres to all department policies and procedures. Ability to hold themselves accountable to front-end performance while not performing the work
• Follows organizational policies and procedures to ensure consistency of charge capture processes and reimbursements.
• Takes responsibility for maintaining knowledge level after training by keeping current on procedures pertaining to each area. Responsible for reading posted notices, memos, and emails.

Communication

• Keep leader informed of progress of all tasks.
• Partners with practice staff, practice managers, providers, and Front-End Operations Team members.
• The individual in this role will review processes and flows and make recommendations for possible enhancements.

Performance Monitoring/Improvement

• Review Workqueues and Hold Buckets completes task as assigned.
• Creates, analyzes and implements processes to improve the quality of front-end revenue cycle operations through key performance/operations indicators.
• Identifies process flow or operational structure problems impeding financial outcomes, proposes solutions, and collaborates with department to implement corrective actions.
• Analyzes, monitors and communicates financial and operational performance, trends and results to stakeholders.
• Associate works and reviews payer acceptance/reject reports when indicated.
• The goal of the associate is to produce accurate and timely claims in order to prevent denials and maximize reimbursement.
• The associate is responsible for working claim edits within the patient accounting system and claim scrubber edits prior to final submission
• Responsible for reviewing documentation to help ensure accurate charge capture.
• Analyze charge review rules that require review
• Execute edits within charge review to achieve account resolution
• Resolve all correction requests accurately and in a timely approach.
• Ensures any edit is made prior to the 90-day mark
• Responsible for performing edits on high dollar accounts
• Scope of responsibility may include utilizing reports to monitor volumes and overall success rates.
• Act as a point of escalation and monitor supervisory or secondary work queues.
• Ability to hold themselves accountable to front-end performance while not performing the work.
• Ability to solve complex problems and provide documented solutions and recommendations to clients.
• Reviews, corrects and completes all items collected in assigned workqueues or claim bucket. Ensures all errors are corrected and resubmitted.
• Completes all additional duties as required.
• Interviews patients and/or family members to obtain accurate financial and demographic information to ensure prompt payment.
• Verifies the patient’s insurance through the on-line eligibility system and determines which payer to enter in the account to minimize denials.
• For outpatient exams, completes an estimate of charges to determine patient’s liability. For all other patients, determines financial liability from the insurance response and collects any amount due from the patient.
• Scans all requirement documents and obtains all appropriate signatures from patients. Completes all forms required by governmental or commercial payers.
• Following the AIDET principles, interacts with physician’s office staff, physicians, and other employees of the organization according to goals of the department while maintaining appropriate (need to know) patient confidentiality.
• Maintains current knowledge of all insurance cards and billing necessities to obtain accurate demographic, financial, and clinical information and signatures from patients (or POA) as determined by Medicare, State and Federal guidelines.
• Retrieves and posts charges for all designated providers into the practice management system timely and accurately.
• Exhibits strong communication skills and positive attitude with internal (team members, other departments, and leadership) and external customers (patients, insurance companies, vendors, and employers). Defuses volatile situations in a calm, objective, and tactful manner. Directs customer complaints to management for immediate response if unable to resolve.
• Monitors charge capture reports to ensure complete capture of all billable services.
• Coordinates activity with internal and external customers and serves as contact person for issues relating charge capture.
• Ensures that charges are posted timely. Monitors charge entry lag and reports any delayed or missing charge issues to the Manager of Coding, Compliance, and Auditing.
• Generates end of day reports to validate charge entry accuracy.
• Monitors LCD, NCD, and CCI edits to promote clean claim submission.
• Data enter and review physicians claims in billing system
• Apply all coding rules and use of CPT and ICD codes and appropriate use of modifier
• Identify and report to management payer issues with regards to billing and collections.
• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers.
• Edit claims to meet and satisfy billing compliance guidelines for electronic submission.
• Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory

Innovation

• Demonstrated ability to work independently to ensure Revenue Cycle operations are managed efficiently and effectively
• Always looking for automation and efficiencies
• Able to perform in depth analysis to define the root cause of an issue as well as identify efficient and effective solutions
• Must be an independent thinker
• Assist in developing policies and procedures related to Charge Review and Claim Edit Review
• Generate reports to monitor the types of errors and their frequency
• Research accounts and request any needed supporting documentation
• Document and trend errors provide trends to leadership
• Provide backup assistance to other Practice Operation Analyst team members on different teams.
• Cross-trains to other front-end revenue cycle areas to ensure efficient knowledgeable coverage as needed. Preforms other job functions as needed per patient volumes.

Scheduled Weekly Hours

40

Work Shift

Days (United States of America)

We’ll Also Reward Your Hard Work With

• Great health, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• Paid time off
• Tuition reimbursement
• And a lot more

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact our Human Resources Department at 877-692-7780 or [email protected]. This department will make sure you get connected to a Human Resources representative that can assist you.

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