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Revenue Cycle Software Applications Analyst

POSITION SUMMARY:

The Analyst, Billing Software Applications is responsible for maintaining data tables within BRLI's revenue cycle billing and claims systems. The position is responsible for vendor relationships and vendor systems maintenance and updates. The Analyst is responsible for daily system table updates, overall system development, testing, tracking, and delivery with accurate and timely updates to the billing software system to enhance productivity and revenue cycle. The position is also responsible for entitlement reviews and help desk review and approvals.

PRINCIPAL JOB DUTIES

Duties may include but are not necessarily limited to the following:

  • Implements and maintains multiple data-based table setup edits to ensure timely and accurate billing
  • Maintains/performs one or more of the following: accurate payer demographics, EDI/ERA enrollment via software billing vendor, EDI claims submission tracking including the submission file, payer billed and payment trends and tracking, payer eligibility on the plan level identification and mapping, client insurance identification and assignment of internal insurance codes, canned system notes, client billing rules, payer billing override rules, payer rules for member ID format payer field requirements, payer submission service method, physician billing payer exclusions, healthcare denial code setup by payer, CARC and RARC reason codes, payer/CPT rules for internal workflow such as Prior Authorization setups, employee access to payer website portals, new user requests and changes to existing users, supports entitlement audit for existing user rights, revenue cycle ticket log and explanations for billing vendor issues
  • Analyzes complex excel files from existing billing software tables to facilitate table audits and updates
  • Processes and analyzes EDI transmissions for tracking and monitoring outbound files
  • Reviews payer adjudication code setups such as CARC and RARCs (reason codes) and analyzes and updates system actions
  • Analyzes revenue cycle and payer adjudication cycle trends and digs into data to identify impacts and process improvements
  • Runs system reports on a daily basis and denotes trends
  • Maintains records of user access including user and access in support of Security and Audit guidelines
  • Maintains direct knowledge of current and future capabilities of billing software for revenue cycle with focus on productivity, development and cash acceleration
  • Identifies, tracks, and resolves missing/lost/incomplete submission and remittance files
  • Collaborates with multiple departments (internal and billing software) for problem resolution
  • Maintains a strong understanding of new technology and its application to our business
  • Supports various files as key owner with backup responsibility for other files
  • Applies company policies and procedures to resolve routine issues.
  • Other duties as assigned

EDUCATION:

  • BA or BS degree required

EXPERIENCE AND REQUIRED SKILLS:

  • 3+ years' experience on a software applications team, preferably in a healthcare environment
  • Experience with billing system implementations and file maintenance
  • Experience in the total testing cycle of an implementation and updates
  • Excellent computer skills: Microsoft Office programs
  • Independent thinker and initiator with excellent organizational and time management skills
  • Strong oral, written and interpersonal communication skills with a hands on approach to work with company units and subject matter experts
  • Knowledgeable of best practices to improve existing organizational methods and system processes
  • Knowledge of healthcare payers and claims adjudication
  • Comprehensive knowledge of healthcare insurance payers and plans
  • Familiarity with OIG/CMS compliance regulations pertaining to claim adjudication
 
BioReference Laboratories is an Equal Opportunity Employer
 


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