Responsible for implementing, designing, and providing support for business and administrative claims revenue cycle claims denial analytics. Develops dashboards and reports with key performance indicators, metrics, data points, and formulas to support management objectives by providing useable data for decision making. Assists revenue cycle leaders in working closely with administrators, providers, payers, and other staff to investigate and design initiatives in order to improve revenue cycle claims denial statistics, reporting capabilities, and overall performance/workflow improvements. Determines how processes can be aligned with best practices to achieve optimal results, measurable change, and a quantifiable, positive contribution.
The following describes the basic position duties that an employee MUST be able to perform for this role. This information is intended to be descriptive of the key responsibilities of the position. The list of essential functions below DOES NOT identify all duties performed by any single person in the position.
Requires depth within a specialized, critical discipline and/or breadth of substantive professional knowledge that crosses disciplines within the professional field
Interprets internal/external business challenges and recommends best practices to improve products, processes or services
May lead functional teams or projects with moderate resource requirements, risk, and /or complexity
Leads others to solve complex problems; uses sophisticated analytical thought to exercise judgment and identify innovative solutions
Impacts the achievement of customer, operational, project or service objectives; work is guided by functional policies
Works independently, with guidance in only the most complex situations
Communicates difficult concepts and negotiates with others to adopt a different point of view
JOB SPECIFIC RESPONSIBILITIES:
Analyzes quantitative and qualitative data as necessary throughout the course of the denials management program, including the development of data collection strategies. Performs data analysis and summarizes findings for leadership review.
Interprets and manages data within relational databases to ensure expeditious access, meaningful relationship, validity, pertinence and reporting timeliness.
Reviews reimbursements and variance reports to identify and trend payment discrepancies (e.g., denials, underpayments, etc.), reporting results to leadership on a regular basis. Tracks the status of all denial response efforts carried out by Children's Health System of Texas (CHST) Denial Management Unit staff and vendors through CHST’s denial tracking tool/systems.
"Develops performance dashboards with key performance indicators, formulas, and other reimbursement related
data to track reimbursement trends for both individual providers, staff members, and the overall departments/service areas"
Prepares, maintains, reviews and submits denial/payment reports that create interest, impact, and credibility for decision making to management.
Manages process improvement technical initiatives and projects within the enterprise revenue cycle by recognizing process improvement opportunities, engaging stakeholders, conducting and communicating root cause of denials (e.g., discrepancies in patient account information, coding, charging, documentation, etc.) and developing and executing plans to achieve best practice efficiency.
Serves as a resource to download and compile benchmarking and best practices data.
Designs and develops concise reporting packages and dashboards to support key business functions and initiatives related to revenue cycle, such as denial prevention, productivity management, quality control initiatives and late charge prevention.
Identifies potential sources of revenue leakage and assists in developing data-driven initiatives to resolve any issues.
Helps design and implement improvements to established or proposed reimbursement process flows in an effort to maximize potential revenue.
Completes additional assignments and maintains current knowledge of the denials management field by following industry trends, as well as completing any required ongoing training and instruction.
Minimum seven years of experience working in a healthcare environment required.
Minimum five years of experience in healthcare analytics with Crystal Reports to include creating and writing reports required.
Minimum five years advanced experience with Microsoft Excel (pivot tables and pivot reporting, lookup, advanced formulas) required.
Microsoft SQL experience to write scripts preferred.
Four-year Bachelor's degree or equivalent experience required.
LICENSES and CERTIFICATIONS:
Epic Clarity Data Model - Resolute Hospital Billing required.
Specific Knowledge, Skills and Abilities:
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Effectively manage one's time and resources to ensure that work is completed efficiently.
Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.
Assimilate and apply new job-related information in a timely manner.
Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
that Children’s Health provide for our patients and employees makes this an enjoyable place to be. As a system, there is a lot of room for professional and personal growth, with opportunities to further your education and your career.
Point of Care Coordinator