Business Systems Analyst 3 - Revenue Integrity - F/T Days

at  UC Irvine Medical Center

POSITION SUMMARY:

This position plays a key role in the organization’s move towards more revenue cycle automation using existing Epic functionalities, 3rd party applications and/or AI (artificial intelligence) /RPA (robotic process automation) tools (e.g. UiPath, Microsoft Power Platform, etc.) to optimize efficiencies for existing and new workflows/processes while remaining compliant with healthcare regulations. Also responsible for implementing, maintaining and troubleshooting specified systems, workflow processes, data flows, information transmissions, etc. throughout the receivables cycle. Using a collaborative process, will contribute significantly to reporting and analysis of relevant KPI metrics resulting from automation efforts that could encompass Registration, HIM/Coding, Revenue Integrity, Research Revenue Integrity, Patient Financial Services, Professional Billing Group, Shared Business Office departments.

REQUIRED QUALIFICATIONS:

Demonstrated knowledge of Excel, Access, Word
Knowledge of registration, billing and collections processes and data requirements gained through at least two years experience working in a hospital based environment utilizing an automated Patient Accounting system
Ability to lead others on a project basis
Ability to identify process improvement opportunities and develop and recommend new processes as needed
Strong analytical skills with the ability to summarize key information clearly and concisely
Strong oral and written communications skills to effectively communicate with staff, senior management and external constituents
Ability to think critically and problem solve independently as well as collaboratively as required
Ability to work independently and take initiative to identify priorities and manage workload accordingly
Ability to read and understand intent of regulatory documents to be able to assess impact on current operational processes
Familiarity with rules and regulations governing various payers
Strong knowledge of healthcare automated systems utilized in a Business Office environment

PREFERRED QUALIFICATIONS:

Bachelor’s Degree in Business, Finance or Computer Sciences
Knowledge of UC policies and procedures
Project management experience
Specific knowledge of Invision Patient Accounting System
Understanding of billing related EDI formats and requirements

Maintains specific master files and billing system and sub-systems
Accurately performs net revenue analysis
Effectively serves as a resource to senior management regarding the functionality of existing manual and automated business office systems
Prepares and distributes weekly reports to PFS management summarizing key information and identifying trends as appropriate. Determines best formats for data and results presentations
Maintains and applies a detailed knowledge of the registration, billing and collection processes and data requirements to ensure assignments are completed effectively and efficiently
Maintains safety and security procedures for Invision system integrity
Effectively implements, modifies and troubleshoots specified computer systems, data flows, information transmissions and report designs throughout the receivables cycle
Collaborates and/or contributes to the analysis of accurate data exchange between Registration, PFS Patient Accounting, Revenue Audit and the current in-house claim scrubber
Effectively assesses need for and provides communications and education/training to billing supervisors and managers
Assesses project scope and develops project plan to include project definition, resources needed, action items, timelines, milestones, decision points and implementation and communication requirements
Coordinates follow up on plan action items and documents plan progress against timeline and decision points. Documents deviations from the plan and reasons for the deviations
Effectively serves as liaison and communicates progress to appropriate members of the management team and others as needed
Oversees implementation of new or changed processes resulting from project to include testing, communications, training, roll-out and follow up assessment
Works with external vendors and consultants as needed to see project through to completion
Effectively manages project plan. Ensures timelines are met, people and other resources are used effectively and efficiently, and performance of vendors is held to plan expectations of performance. Completes project summary at project end
Effectively schedules and leads team meetings. Assigns work based on team member strengths and follows up to ensure team members have the necessary resources to follow through
Serves as a key resource in the organization’s transition to electronic billing (EDI) and electronic payment posting
Effectively analyzes new proposals or initiatives. Identifies creative solutions and prepares alternative recommendations as appropriate
Collects and assembles analytical and factual data appropriate to assigned problems. Effectively maintains information in formats that facilitate reporting needs
Effectively determines, locates and evaluates sources for collecting credible information and data
Develops and presents effective recommendations to supervision/management
Effectively makes internal and external contacts as necessary to obtain or validate data
Makes recommendations for improving existing processes based on analysis and follows through as appropriate
Appropriately plans, coordinates and implements recommendations
Obtains information from appropriate internal sources to answer questions
Effectively uses computer systems, including TDS, Quest or Diamond
Maintains a current working knowledge of Federal, State, University and industry regulations and accounting standards
Responds effectively to questions regarding patient accounts and provides an accurate explanation of charges
Troubleshoots unresolved problems. Researches facts, evaluates alternatives, and interacts with others as appropriate to achieve resolution
Assists in the resolution of customer complaints/issues (re: care, charges, service, etc.) by providing information in the most efficient way, seeing problem completely through to resolution
Proficient in the interpretation and application of financial policies and guidelines
Accurately reviews exception reports and works with staff to ensure corrections
Consults with managers and staff regarding identification of billing and reimbursement issues
Effectively analyzes data between the HCC system and Decision Support system and recommends necessary changes