Revenue Cycle Systems Analyst - Manning - Accounting

Salary: $30.50 - $44.17 per hour, depending on qualifications

Schedule: Monday through Friday

JOB PURPOSE:   The Revenue Cycle (RC) Systems Analyst as part of a team is responsible for performing administrative and fiscal duties, tasks, and assignments in support of the Business Office and its varied operations. The Revenue Cycle Systems Analyst is specifically responsible for the input and maintenance of El Rio Health payer contract data to the billing system to ensure that incoming revenue is in accordance with payer’s contractual obligations. The RC Systems Analyst also supports the Controller and Business Office leaders by compiling and analyzing Accounts Receivable and Revenue trend data that uncovers system and process errors. The RC Analyst is instrumental in facilitating system and process fixes to ensure the submission of clean claims, improve revenue capture, and to provide analytical trend data that supports data-driven decisions. Performing the functions and requirements for this position will follow standardized procedures and policies requiring complex judgment in their execution and will always remain within the defined scope for the position.

An employee in this position works with general supervision and reviews any work problems involving departures from standard policies, interpretations, or procedures that are presented to the supervisor for resolution.

Essential Job Functions:

1. • Proactively searches for systems and data anomalies to identify issues and opportunities for manual and system corrections.
   • Inputs and maintains contracts and benefit plans in the system.
   • Tests contracts and benefits plans to ensure output as expected. Creates and maintains data for internal and external Revenue cycle analysis and modeling and explains and translates findings into general terms for non-technical audiences.
   • Documents business processes/procedures and makes recommendations for workflow improvements and optimization.
   • Serves as administrator for claims vendor and other related operational applications. Responsible for the on-going maintenance, testing, development of workflows, workflow analysis, change documentation, application support, monitoring and optimization of EPIC maintained systems.
   • Participates in and/or leads the implementation or enhancements of systems, software, and solutions to system related problems, specific to Revenue Cycle.
   • Evaluates Revenue Cycle needs and facilitates the development of configurations that support business processes.
   • Promotes and actively seeks to develop positive internal (team members) and external (El Rio Health customers) relations.
   • Collaborates across multiple organizational areas.
   • Performs application validation as part of El Rio’s full Revenue Cycle testing policies Identifies and summarizes basic characteristics in data and trends in data patterns related to Revenue Cycle, including, but not limited to, encounters, utilization, denials, payment by payer and undistributed payments.
   • Presents information using data visualization techniques.
   • Meets established time frames and rates of performance for the quality and quantity of work for the position

2. • Analyzes EDI and data requirements from customers and insurance carriers, to ensure clean claim submissions and works to resolve any barriers by working with IT PB EPIC partners to correct claims formatting issues.
   • Acts as a resource to support staff. Interacts with all employee levels on billing/EDI issues.
   • Works closely and cooperatively with IT development/support team on product design; makes recommendations for changes to enhance support and usability.

3. • Gains and maintains a general understanding of applicable Federal, State, and commercial payer requirements, standards, regulations, or laws; as well as all organizational policies and procedures related to healthcare benefits payment and processing.
   • Assists department leadership by performing and completing assigned processing that supports file maintenance within the Practice Management and Electronic Health Records systems.
   • Identifies processing anomalies observed and report these situations or observations to the assigned supervisor in a timely manner.
   • Performs administrative or fiscal duties, tasks, and assignments supporting business office operations within established timeframes; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence.
   • Assists with creating end-user training and documentation.
   • Maintains at all times patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted confidentiality standards.
   • Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
   • Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.
   • Communicates effectively through written, verbal, and interpersonal skills as applied when interacting with employees, internal/external clients or representatives, or patients, successfully conveying and exchanging information in a positive and effective manner.

Other Duties and Responsibilities: 

• In support of the Mission and Vision of El Rio Health, will at all times represent themselves as a professional role model of El Rio Health serving as a positive informational source for members of the community. 
• Supports El Rio Health by participating in community events which promote good health, and which contribute to a broader awareness and understanding of El Rio Health and the many services provided to the community.
• Participates in all appropriate health care activities related to El Rio Health on a local, state, and national level to maintain and enhance El Rio’s image with health agencies, professional associations, and the general public.
• Ensures and supports the cost-effective use of materials, supplies, and equipment by limiting waste of all organizational supplies and resources.
• In accordance with policies and procedures ensures that documentation of hours worked is completed accurately, as well as signed-off/approved in a timely manner.
• Employees must maintain their skills proficiency with El Rio Health operating systems and/or software programs by adapting to changing requirements and successfully learning and demonstrating new skills in response to software, system, and program improvements or upgrades.
• Performs other duties as assigned.

Minimum Education and Experience:

4. • Associates Degree in Finance, Data Analytics, or related field from an accredited college or university. 
   • Experience with Healthcare 5010 X12 healthcare transactions.
   • Two (2) years’ experience working with healthcare data.
   • Experience working with data using standard data tools including databases, spreadsheets, pivot tables, etc.
   • Four (4) years’ experience working in a medical or dental analyst role in a healthcare environment.

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Required Licenses, Certifications, and Registrations: 

• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
• Epic Contract Manager and Revenue Cycle Informatics certification.
• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

All El Rio Health Epic Analyst positions require Epic certification based on the specific role. For candidates who meet minimum qualifications but are not yet Epic certified, the candidate has 90 days from the start date to obtain the required Epic certification. One probationary extension of 30 days may be granted with approval from Management and Human Resources. Exceptions will be made to accommodate Epic training schedules. If the employee does not receive certification for the position within this timeframe, they are ineligible to remain in the position, and may seek other opportunities within the Organization for which they are qualified or may resign.

Preferred Education, Experience, Skills, Abilities:

• Bachelors’ Degree in a Finance or Data related field from an accredited college or university.
• Working experience with EPIC Reporting tools.
• Working experience with Electronic Health Record (EHR) systems, preferably Epic.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

El Rio Health is a diverse and inclusive organization. We are invested in helping you and your family Create Tomorrow.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

El Rio Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

El Rio Health requires all employees (except those 100% working remotely) to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire.

All employees are strongly recommended to obtain COVID 19 and maintain vaccination status (i.e. as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Personnel who decline to receive COVID 19 and/or flu vaccination per most recent CDC recommendations will be recommended to wear a facemask while in an El Rio Health facility, including both clinical and non-clinical areas from November 1 to April 30 (subject to change depending on viral activity). Subject to exemptions and accommodations when required by law.

All employees are required to undergo drug testing prior to employment and, will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.