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FirstHealth of the Carolinas · 10 hours ago

Revenue Cycle Management Analyst

Pinehurst, NC

Full-time

Onsite

Entry, Mid Level

1+ years exp

FirstHealth of the Carolinas is seeking a Revenue Cycle Management Analyst who will work collaboratively with billing staff and management to analyze payer denials and improve workflows. The role involves maintaining knowledge of the revenue cycle, completing payer appeals, and collaborating with various departments to ensure compliance and efficiency.

Health CareMedicalNon Profit

Responsibilities

Understands all revenue cycle processes across FirstHealth entities (e.g., Pre-Services, Registration, Charge Entry, Coding, Billing, Collections, Denials)

Compiles and organizes information for presentation to management with analysis and recommendations

Identifies and reports unusual trends; investigates and proposes improvements

Assists in charge structure and coding reviews to ensure regulatory compliance and proper service charges

Reviews failed claims and coordinates corrections with appropriate personnel

Monitors CMS and payer websites for updates affecting billing and reimbursement

Educates and shares relevant updates with staff

Understands managed care and government reimbursement performance

Researches root causes of denials and supports corrective action planning

Maintains professional appearance and demeanor in all interactions with employees, applicants, and visitors

Assists with the Hospital Financial Audit

Supports management with special projects as needed

Serves as a liaison between the managers, Finance, Business Office and Compliance on billing and charging issues

Qualification

Healthcare financial analyticsCertified Professional CoderMicrosoft ExcelCPT-4 CodingICD-10 CodingEPIC systemAnalytical skillsTeamworkCommunication skills

Required

Certified Professional Coder certification is required (can be obtained within six (6) months after hire)

Must possess strong Microsoft Excel and analytical skills

Preferred

Bachelor's degree in Accounting, Finance, or Healthcare administrative field preferred (a combination of experience and education will be considered in lieu of a degree)

One to three years in healthcare financial analytics or hospital/professional billing experience is preferred

Experience with commercial and governmental payers is preferred

Knowledge of CPT-4, HCPCS, UB-04, HCFA 1500 and ICD-10 Coding as well as OPPS & CCI edits

Knowledgeable in EPIC and other patient financial/accounting systems

Ability to work independently, exercising sound judgement, discretion and initiative

Leads meetings and workgroups

Influences and contributes to strong sense of teamwork and collaboration

Proficient in using personal computers and Microsoft Office products