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REVENUE ANALYST - CLINIC - HOAG CLINIC ADMINISTRATION (Costa Mesa, CA, US)

Company: Hoag Memorial Hospital Presbyterian
Location: Costa Mesa
Posted on: June 10, 2021

Job Description:

The Revenue Analyst is a technical expert relative to Government and Managed Care Facility reimbursement, including overall revenue cycle reporting with emphasis on AR management.

As part of the Finance Revenue team, this position will support Managed Care Contracting for contract modeling and revenue impact analysis in support of negotiations, helping to identify underpayments, and tracking profitability within our contract models. This position will also prepare analyses related to the financial impact of Medicare and Medi-Cal changes in reimbursement in order to identify financial and/or operational impacts to revenue.

This position will also have responsibilities to support Revenue Cycle by having direct and in-direct oversight for the identification, coordination and execution of various analytical processes within Revenue Cycle. The position will utilize multiple data repositories to develop reports and trend analysis for on-going accurate and actionable data for AR management and to ensure financial and strategic objectives are consistently met. The incumbent will manage month-end reporting of Revenue Cycle operating results, compiles financial dashboards and write narratives of findings for presentations to Hoag Clinic Administration.

As part of other on-going responsibilities, the position will support the Revenue Finance Team with:

Adhoc revenue impact analysis.

Assist as requested with month end financial analysis.

Provide support in the development of each year's Operating Revenue Budget.

The individual projects an image of professionalism in communication, appearance, and conduct and supports the department and organization's mission and vision. Willing and capable to work independently and in a team environment is essential. Task lists management; accomplishing quality results on time in a high demand environment are required. The position will act as a financial resource for leadership across all business units.

Essential Functions

  • Supports Managed Care Contracting proposed negotiations by modeling payor contracts in an effort to identify effective rate proposals.
  • Prepares analysis related to the financial performance of existing Managed Care contracts, in order to identify the financial performance of those agreements. Recommends areas of improvement.
  • Perform monthly capitation payment reconciliation for all commercial and Medicare Advantage payers and follow up with payers as needed to obtain accurate capitation payments.
  • Analyze shared risk pool arrangements and facilitate periodic settlements.
  • Develop accrual process for Mid-year and Final RAF adjustments to minimize unexpected revenue fluctuations.
  • Coordinates communication within the department and between departments regarding changes in existing or new Managed Care contracts.
  • Compiles daily, weekly, and monthly statistical reports necessary for successful management of Revenue Cycle Operations and AR management.
  • Possess expert analytical skills necessary to evaluate material variances, trends, and correlations in A/R, revenues, reimbursement, and volumes.
  • Assists in projecting Hoag Net Patient Revenue for the Operating Budget, Long Range Financial Plan and Month End Close, as applicable.
  • Serves as a financial resource for clinical and non-clinical areas.
  • Perform other duties as assigned.

Education, Training and Experience

Required:

  • Bachelor's degree in business administration, finance, accounting, or healthcare administration.
  • 3-5 years' experience as an analyst in a healthcare environment with emphasis on provider revenue and reimbursement

Skills or Other Qualifications

Required:

  • The individual possesses a strong understanding of Managed Care and Government reimbursement methodologies. Exhibits a working knowledge and understanding of different reimbursement methodologies such as fee-for-service, capitation, case rates, etc.
  • The individual has a solid understanding of hospital Revenue Cycle: Patient Accounting/Billing, AR management, and claim data processing). Proven excellent communication and customer service skills, including the ability to progressively investigate, analyze and identify sources of problems, provide practical solutions, and negotiate resolutions.
  • Strong computer technical skills required, including proficiency with Microsoft Office products (Excel, Access, and some PowerPoint), Allscripts EPSI and EPIC knowledge a plus.
  • Skilled at analyzing large data sources; strong SQL/SAS skills.
  • Ability to make independent business decisions, considering both the impact to client satisfaction and overall financial impact for the department and organization. Ability to streamline processes for efficiency. Strong analytical aptitude and experience creating financial models. Possesses good sense of general business acumen.
  • Strong understanding of DRG and CPT/HCPC Medical Coding and Medical Terminology.
  • Basic understanding of Accounting Principles and Hospital Financial Reporting.
  • Familiarity with Medicare Risk Adjustment process.

License and Certifications

Required:

  • N/A

Preferred:

  • N/A

Position Reports to: Director of Health Plan Revenue

Keywords: Hoag Memorial Hospital Presbyterian, Costa Mesa , REVENUE ANALYST - CLINIC - HOAG CLINIC ADMINISTRATION (Costa Mesa, CA, US), Other , Costa Mesa, California

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