Career Center

HYBRID POSITION: Must Reside in NORTH CAROLINA

General Description of the Job Class

Coordinate, prepare and analyze complex accounts receivable and/or financial reports. Review and analyze trends, advising PRMO, DUHS and DHIP leadership regarding conclusions and recommendations. Serve as expert resource in the decision-making process for covered area.

Duties and Responsibilities of this Level

55% Service Now Review/Testing:

·       Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes and work with Management to request and implement those improvements.

·       Enter Service Now tickets for system changes.

·       Perform positive and negative testing of system changes to ensure appropriate updates are made and validate the process once the changes are moved to production.

·       Collaborate with DHTS Maestro Care team to communicate operational needs, coordinate testing efforts, and ensure appropriate turnaround on changes and resolution of tickets.

·       Serve as an expert resource to leadership in decision-making process.  Plays an integral role in implementing and managing changes related to the area of expertise.

·       Become a subject matter expert related to system logic and functionality.

·       Primary tester and liaison for system upgrade testing which includes performing parallel testing and providing feedback to leadership on issues found during testing.

·        Initiate and implement system logic changes per review of payor bulletins and guidelines.

·       Review incoming requests for optimization; prioritize based on operational needs and strategic priorities through collaboration with the Business Process Consultant and operational owners.

·       Monitor incoming tickets to ensure timely resolution

·       Participate in the testing of new system changes and enhancements to ensure successful implementations

·       Follow up with key stakeholders to ensure timely testing and system availability to ensure the timeline of system implementations are not negatively impacted.

·       Create timely user notifications based on system changes-collaborating with operational owner. 

·       Communicate timely identified system breaks and provide steps/timeline for resolution to mitigate negative impacts to daily business operations

40% AR Review:

·     Identify trends and opportunities for improvement for operational, payor, system and/or user issues.

·       Monitor work queues and reporting to identify trends associated with operational systems.

·       Escalate trends to management with recommendations for resolution with ideas/opportunities.

·       Proactively monitor payor rules and regulations related to claims logic build and billing guidelines.

·       Review volumes for patients access work queue rules (e.g. patient work queue rules, claim edit work queue rules) and identify missed or inappropriately routed appointments, accounts, or invoices

·       Submit service re quest to resolve issues identified with work queues or work queue rules; participate in testing enhancements or fixes for release to the production environment.

·       Review patient access related service requests for work queue rules breaks (e.g. patient work queue rules, claim edit work queue rules) and resolve the ticket

·       Assist with facilitation of workgroup meetings including updating project log and validating testing within the system.

·       Prepare written reports and analysis for PRMO, DU HS and DHIP leadership highlighting trends and appropriate recommendations/conclusions.

·       < /span>Maintain liaison with DUHS, PRMO and DHIP management and staff, documenting reports and analysis and discussing results, trends and recommendations.

·       Conduct detailed research to identify trends, including a review of specifics in the appropriate accounts receivable and/or financial systems.

·       Act as a technical resource to operational management and staff on the appropriate interpretation of accounts receivable and/or financial data. Coordinate and mentor staff regarding accounts receivable and financial systems, analyses, reports and policies/procedures.

·       Monitor KPI's to identify themes and opportunities for improvement

·        Provide recommendations to enhance workflows to improve processes that would lead to positive outcomes

·        Collaborate with operational owners to provide action plans for resolving any outstanding trends which negatively impact overall business operations

·         

5% Other

·       Organize and lead committee meetings across DUHS, PRMO and DHIP as it relates to accounts receivable and/or financial data operation improvements.

·       Perform other related duties incidental to the work described herein.

Required Qualifications at this Level

Education:

Bachelor's degree in business, healthcare administration, accounting, finance or a related field is required

Experience:

Minimum of four years of applicable experience.

Previous experience successfully managing complex projects involving multiple stakeholders with a consistent track record of delivering on time, or high-quality results preferred.

A master's degree in a related field can substitute two years of experience on a 1:1 basis.

Knowledge, Skills, and Abilities:

Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, PowerPoint) Good communication skills (verbal and written) are essential.  Knowledge of Epic and IT related training/testing is essential.