The primary purpose of the Revenue Cycle Analyst position is to improve the revenue cycle at the Department of Public Health by analyzing and optimizing the processes that generate funds for the department. This position works with colleagues to ensure accurate, timely, and compliant medical billing and collection is completed in accordance with billing policies and regulatory requirements.
Essential functions listed below represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.
Monitor, analyze, and report on all components of revenue cycle from patient registration to final payment.
Monitor revenue cycle performance metrics such as denial rates, collection rates, and financial trends.
Evaluate billing and reimbursement processes to identify areas for improvement.
Ensure billing codes (CPT, ICD-10, HCPCS) are correctly captured and reflected.
Review claim denials, analyze root causes of high denial areas, and coordinate corrective actions to reduce rejections.
Implement preventive measures by adjusting workflows to reduce denials.
Contact patients and payors as needed to solve problems.
Monitor, evaluate, and complete various work queues in the electronic records system.
Assist with revenue backlogs to ensure timely posting.
Analyze large data sets using Excel (pivot tables) and other tools.
Prepare financial reports and dashboards with monthly/quarterly summaries to support leadership decision-making.
Collaborate with clinical program managers, registration team, billing team, finance team, and IT to improve revenue workflows.
Conduct team meetings to assess revenue trends and discuss projects for improvement.
Develop training materials and teach staff revenue cycle procedures, improve workflows, and ensure best practices.
Work with IT and UNC EPIC to optimize electronic health record system (EHR) to support revenue generating projects.
Contribute significantly in the implementation of workflow changes by project managing and training staff as needed.
Suggest and assist with special projects related to the revenue cycle.
Conduct audits related to registration, billing, and financial performance including analyzing metrics such as denial rates, clean claims, and overall patient data to prevent compliance or reimbursement issues.
Ensure compliance with Medicaid, Medicare, and other payer regulations.
Assist with budgeting, forecasting, and audit preparation related to revenue.
Stay current with regulatory changes and ensure processes align.
Suggest and support internal and external audit requirements through controls testing, data reconciliation, and documentation.
Performs related work as assigned.
Knowledge of various financial and operational metrics to inform decision-making and strategy development in healthcare settings.
Knowledge of HIPAA, NCDHHS Coding and Billing Guidance, NCPH Administrative and Clinical Coverage Policies, NC Administrative Codes, NC Immunization Program Coverage, and Family Planning Title X Guidance.
Knowledge of medical billing and coding (CPT, ICD-10, etc.) processes.
Knowledge of electronic health record (EHR) systems, preferably EPIC.
Knowledge of payer regulation.
Proficiency in Excel and data visualization tools.
Skilled in maintaining effective working relationships with patients, payors, and other employees.
Skilled in collaborating with teams of colleagues to solve problems.
Strong analytical, project management, and problem-solving skills.
Proficiency in Excel and data visualization tools.
Ability to provide excellent communication, both verbal and written.
Ability to be a systems thinker focused on identifying areas for process improvement to enhance efficiency in healthcare operations.
Ability to independently plan and organize individual work and various group projects simultaneously.
Bachelor's degree in health administration, public health, finance or a related field from an appropriately accredited college or university and two (2) years of experience in healthcare revenue cycle or billing operations or; Six (6) years of experience in healthcare revenue cycle or billing operations.
Experience with EPIC is preferred.