The Revenue Capture Business Analyst position conducts and assists in the detailed analysis and evaluation of department financial and operational key performance indicators, and effectively deliver simple to moderately complex financial, statistical and/or operational reports as assigned. Conducts detailed analysis and review, focusing on physician documentation to ensure timely and appropriate coding for predefined patient demographics. Comparison of Electronic Medical Record (EMR) to billing systems to ensure accurate coding and billing practices. Reports shortfalls and trending issues related to EMR/TES edit information that prohibits accurate charge or data capture. Analysis of assigned physician and hospital services provided in clinical/outreach facilities including outreach services from other institutions. Completes all TES edits based on predetermined policies to ensure all services are processed timely and accurately, maintaining revenue integrity set forth by the Revenue Management department. Follows diagnosis and procedure coding activities based on predetermined policy, to ensure that services are submitted for payment to the patient and/or their insurance carrier in a manner which accurately optimizes revenue reimbursement. Further, this position will work with other Revenue Management areas to support auditing activity for hospital and professional charges and act as the first line of defense regarding compliance as it relates to documentation and charge capture integrity.
Performs duties to promote a culture of collaborative, customer-focused service delivery with both internal and external team resources to ensure patient satisfaction.
Directly accountable to the Manager of Revenue Capture.
SPECIFIC POSITION DUTIES:
Assist to review Revenue Capture operational business processes and identify opportunities for improved outcomes. Additionally, support efforts to audit Revenue Capture policies and procedures to ensure compliance of published Revenue Capture protocols.
Effectively adheres to the Revenue Capture Business Analyst process, including timely acceptance of assignments, appropriate prioritization of project requests, and feedback to requestor regarding status/delivery date.
Ensures that Revenue Capture Business Analyst assignment processes follow the prescribed data integrity & controllership protocols, including adherence and compliance with policies set forth.
Provide in-depth process training to new and/or established staff members as assigned by Manager.
Ensures all Revenue Capture workflows and policies are adhered to.
Audits records for Third Party Defense to ensure that all charges billed were appropriate and mitigate insurance take backs.
Compares documentation to the detail charges and communicates difference to Revenue Management to ensure charge compliance and accurate billing.
Maintains high level of accuracy while performing timely correction of system edits.
Ensures the maintenance of confidentiality for both the medical and financial information on patients who have received services from Geisinger.
Performs all duties in a timely and accurate manner to ensure correct submission of billing information to insurance companies and/or patients, and completes tasks with a minimal amount of direct supervision. Reports any issues or concerns to Manager.
Assists and provides coverage for other team members in the completion of their assigned duties to ensure timely and accurate processing of charges.
Participates in a minimum of 10 hours of online training, team meetings, in-services, etc. per year.
Works in conjunction with other areas within Revenue Management and Geisinger departments to ensure coordinated activities, with respect to all Revenue Management needs.
COMPETENCIES AND SKILLS:
Demonstrates documentation review experience, including both inpatient and outpatient settings required.
Demonstrates advanced computer skills including Microsoft Office, with an emphasis on Excel spreadsheet manipulation required.
Demonstrates good organizational skills. This position requires a high level of concentration with outstanding analytic and reporting skills to be successful.
Demonstrates ability to meet standards set forth for both productivity and quality of work. And the ability to communicate effectively with various levels of the organization.
Demonstrates both oral and written communication skills. Must be able to make responsive, sound and accurate decisions.
Demonstrates the ability to work independently with minimal supervision.
Advanced Microsoft excel knowledge required for report manipulation and assignment to team members based on predetermined criteria.
Knowledge of automated billing systems (EPIC, IDX, Cerner, CAM, Ingenious Med, etc.) preferred.
Demonstrates the ability to effectively incorporate identified reporting requirements into assigned areas of work.
EDUCATION AND/OR EXPERIENCE:
Bachelor’s degree in Business, Finance or other related field required.
Associate’s degree in Business, Finance or other related field required. Minimum of two years of revenue cycle, finance, or related experience required
In lieu of a degree, may consider minimum of four years’ experience as a Revenue Capture Specialist II or equivalent required.
Experience in medical record documentation review, working with TES edits as well as GHS billing systems, ICD-9/ICD-10 diagnosis coding, CPT procedure coding, Microsoft Office, basic mathematical calculations, anatomy and physiology, and medical terminology required.
Experience in a high-volume Revenue Management Department preferred.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.