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LCMC Health · 2 months ago

Pricing Analyst - Revenue Integrity

New Orleans, LA

Full-time

Onsite

Entry, Mid Level

2+ years exp

LCMC Health is a community-focused healthcare organization dedicated to providing exceptional care. The Pricing Analyst will be responsible for analyzing and monitoring pricing, cost, and budget data to enhance financial performance, ensuring compliance with regulations and collaborating with various stakeholders to optimize pricing strategies.

Health CareHealth DiagnosticsHospitalMedical

Responsibilities

Assist with annual rates and establishment processes for both hospital and professional charging /billing, for LCMC Health, including but not limited to:

Obtaining benchmarking data, volumes, reimbursement, and other information required to complete annual fee reviews to ensure pricing remains current and competitive

Compile data

Reporting as needed

Assist with annual CPT code change process for both hospital and professional billing, for LCMC Health, including but not limited to:

Communication with various stakeholder groups such as Revenue Cycle Leaders, CDM Coordinators, Coding, Contracting, Reimbursement Managers, Revenue Cycle Directors, IT, etc

Compile data

Reporting as needed

Conduct detailed analysis of internal cost data, revenue, and payer contracts to evaluate pricing accuracy and financial impact

Monitor market trends, including competitor pricing and reimbursement patterns, to ensure the hospital's prices are aligned with industry standards

Identify opportunities for optimizing pricing structures to enhance revenue capture and improve profitability

Provide recommendations to leadership on potential adjustments to pricing models that could lead to increased revenue or reduced costs

Utilize knowledge of the healthcare industry, clinical and/or business workflows to propose data driven solutions and improvements while working collaboratively with various stakeholders

Ensure that pricing strategies comply with federal, state, and local regulations, including those set by Medicare, Medicaid, and other third-party payers

Maintain current knowledge of regulatory requirements impacting hospital pricing, including transparency laws, billing regulations, and payer guidelines

Work closely with revenue cycle, billing, and finance departments to ensure pricing models align with reimbursement structures and maximize profitability

Coordinate with coding and charge capture teams to ensure that pricing reflects accurate service delivery and coding practices

Develop financial models to assess the impact of pricing changes on hospital revenue and overall financial performance

Utilize these models to project future pricing trends, helping leadership make informed decisions about adjustments or enhancements to pricing structures

Utilize SQL and other query tools to analyze large quantities of data, from multiple complex internal and external sources to glean understanding, derive actionable insights into organizational performance and the external environment, and measure progress toward strategic initiatives

Prepare detailed reports and presentations on pricing strategies, market analysis, and financial impact to share with leadership and other stakeholders

Present findings and recommendations based on data analysis to executive teams for decision-making purposes

Participates in efforts to review and analyze the chargemaster (CDM) to ensure consistency with industry standards and to ensure that change in pricing, CPT/HCPCS codes, and revenue codes are accurate and compliant with billing regulations

Continuously monitor and evaluate the effectiveness of current pricing strategies and models, adjusting as necessary to respond to market conditions, regulatory changes, or financial goals

Develop, produce, validate, and distribute standard charge-related reports and ad-hoc reports as needed

Works hand in hand with CDM Team for pricing of all chargemaster items

Qualification

SQLEpic EHR applicationsFinancial modelingData analysisHealthcare industry knowledgeMicrosoft Office SuiteGAAP knowledgeCustomer service abilitiesAdvanced communication skillsLeadership skillsTeamwork

Required

High School Diploma and six (6) years of experience in accounting, finance or analytics that includes experience with computer systems, spreadsheet and database applications, data reporting and interpretation

Bachelor's degree and two (2) years of experience in accounting, finance or analytics that includes experience with computer systems, spreadsheet and database applications, data reporting and interpretation

Required – HS Diploma

Advanced financial and analytical skills: Knowledge of Generally Accepted Accounting Principles (GAAP) and governmental regulations as applied to health care financial management

Knowledge of SQL, Clarity, and/or other analytical reporting tools

Demonstrates professional standards surrounding data access, security, sensitivity, and confidentiality

Ability to analyze data and workflows to identify complex problems and issues to recommend solutions

Ability to make good judgments in demanding situations

Advanced leadership skills

Advanced communication skills both written and verbal

Ability to develop goals, objectives, and establish priorities

Ability to implement change in a positive, sensitive, and forward-thinking manner

Inspire confidence, good judgment, and the ability to act decisively at the right time

Self-starter with a willingness to try new ideas

Positive, can-do attitude coupled with a sense of urgency

Advanced technical skills: Thorough knowledge and experience in financial system applications and software

Experience in database development and management

Experience in Microsoft Office Suite (Excel, Access, Word, Outlook, and Power Point)

Experience using Epic EHR applications

Knowledge of maintain and auditing the chargemaster (CDM)

Strong customer service and human relations abilities

Ability to effect collaborative alliances and promote teamwork

Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders

Ability to network with Revenue Cycle/Integrity leaders from other organizations

Preferred

Four (4) years of experience in accounting, finance or analytics that includes experience with computer systems, spreadsheet and database applications, data reporting and interpretation, as well as experience using Epic Clarity, SQL, and Epic Chronicles in a healthcare or business administration setting

Preferred - Bachelor's degree in accounting, Finance, Business, Healthcare, Analytics or another related field, or Master's degree in accounting, Finance, Business, Healthcare, Analytics or another related field

Preferred: Epic Certification in any area, CPA