Job Description

Position Highlights

• Department: Finance
• Hours: 40.00 per week
• Shift: Shift 1

This is an onsite position.

Position Summary

The Senior Revenue & Reimbursement Analyst provides oversight and support for Revenue Cycle workflow processes using data analytics. This position works closely with the Revenue Integrity team. The Senior Revenue & Reimbursement Analyst assures all established billing, systems, and process requirements have been met in order to ensure timely and optimal reimbursement. Through the analysis of key performance indicator data, the Senior Revenue & Reimbursement Analyst works to improve Revenue Cycle production and efficiency. The Senior Revenue & Reimbursement Analyst recommends changes that will positively impact the Revenue Cycle and help meet industry benchmarks and meet A/R performance goals and productivity. The Senior Revenue & Reimbursement Analyst will improve and implement internal controls over the revenue cycle and will work closely with IT on interface and system issues as required to improve the flow of data. The Senior Revenue & Reimbursement Analyst may lead projects for the Revenue Cycle. This position will be responsible for complete revenue analytics including month end reporting of gross to net and accounts receivable valuation.

Essential Duties & Responsibilities

• Perform analysis of financial performance of the revenue cycle function to identify areas of opportunity
• Responsible for various standard, recurring reporting functions to support revenue cycle operational business needs
• Assists revenue cycle leaders in working closely with organizational stakeholders to improve financial performance based on analytic findings
• Completes regular root cause analysis of financial transactions
• Monitor key performance indicators for internal and external parties
• Prepares summary findings of analysis for department leadership review
• Cultivates internal relationships to assist in understanding department workflows
• Engage regularly with finance department leaders on improvement opportunities identified through data analysis
• Provides analytics for and supports special projects as needed (e.g. Underpayment review)
• Support investigation into claims patterns, payer mix evaluation and other strategic analytics to optimize payer performance.
• Analyze claims and other healthcare data to identify areas of opportunity and provide recommendations to business stakeholders
• Develop analytical models that are well-documented containing advanced formulas and functions that are used to evaluate historical trends, forecast future expectations, or draw conclusions
• Point person for month end revenue close including gross revenue and patient stat analysis and accounts receivable valuation calculations.
• Explore price transparency data and create meaningful cost of care comparisons to competitor networks
• Develop, improve, and streamline financial processes, reports, and planning tools
• Oversee and enhance institutional cost accounting practices
• Act as a liaison between the Finance division and other hospital areas as well as physician practices
• Collaborate with business leaders and business intelligence analysts to prepare multi-year business plans for new programs and initiatives to identify impact on clinical volumes, organizational and program financials, and evaluate return on investment
• Collaborates with Managers on gross revenue and other factors, then utilizes that information to calculate the budgeted net revenue.
• Works with the Manager on various cost report schedules as assigned.
• Monitor the status of Medicare Cost report appeals, including dates and working with the appropriate individuals on the issues. Creates a tracking mechanism to avoid missed opportunities.
• Completes gross revenue and stat analysis. Works with the various departments on issues.
• Collaborates on various statistical reporting based on the timeframes dictated by the survey. I.E. CHA, AHA, Magnet, DashBoard, etc.

Minimum Qualifications

• 5 years in Hospital Reimbursement and Finance
• Bachelor's degree (preference for Business Analytics, Finance & Economics, Mathematics, Statistics, Data Science, Health Economics)

Preferred Qualifications

• Prior experience with revenue cycle, financial reporting, revenue recognition, analytics and inferential statistics, and use of advanced Power BI tools

Preferred Education:

• Masters in Business Administration, Healthcare Administration or related field

Knowledge, Skills, Abilities:

• Understanding of provider reimbursement, procedure codes (CPT-4, HCPCs), diagnosis codes (ICD-10), and health insurance business.
• Knowledge of payer contracts and contract interpretation
• Good communication skills
• Excellent computer skills
• Strong analytical skills
• Ability to work independently

Comprehensive Benefits Offered

• Competitive and affordable benefits package
• Shift Differentials
• Continuing Education assistance
• Tuition reimbursement
• Student Loan relief through Fiducius
• Quick commute access from I-84, Route 9 and surrounding areas

About Middlesex Health

The Smarter Choice for your Career!

Come join one of Connecticut’s Top Workplaces, and a Magnet designated organization! At Middlesex Health, we have a unique combination of award-winning talent, world-class technology, and patient-first care that's making health care better. Through our affiliation with the Mayo Clinic Care Network, Middlesex Health has access to the most advanced medical knowledge and research available.

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