Cvl Revenue Analyst

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community.

Now hiring CVL Revenue Analyst!

With minimal supervision directly supports the following responsibilities of the Revenue Cycle: reviews, analyzes, and evaluates business needs and user needs by means of performing enterprise wide quality audits of PHS Hospitals, all PMG sites, and Albuquerque Ambulance to ensure compliance and integrity of the Revenue Cycle. Responsible for all activities related to quality audits by means of identifying, documenting, and communicating audit results to all areas of PHS HSL. Coordinates enterprise wide training for areas identified as problematic. Maintains and provides statistical audit reports, documentation and direction to PHS. Verifies that randomly selected claims meet the objective and criteria established by the Revenue Cycle. Responsible for reviewing a statistically valid sample of patient accounts to ensure that patient accounts have all the correct information in accordance to all Government and Non-Government regulations. This also includes ensuring that all PHS policies, procedures and guidelines are being followed throughout the system. Research regulatory agency regulations and correct patient accounts based on audit findings

Ideal Candidate:

At least one year experience in healthcare related enterprise or Revenue Cycle business unit is preferred.  Critical thinking and extreme attention to detail.

Location and Commitments:
Full Time - Exempt: No
Job is based Presbyterian Hospital
Work hours: Days

• Associates Degree or equivalent years of college level courses required. Relevent years of experience may be used in lieu of college degree/education.
• At least one year experience in healthcare related enterprise or Revenue Cycle business unit is preferred.
• Critical thinking and extreme attention to detail.
• Excellent organizational, problem solving, verbal, written communication and ability to interact with other functional areas required.
• Systems operations knowledge of at least one patient accounting system (Medipac, EPIC or Horizon Home Health) and other revenue cycle systems.
• PC experience with Microsoft Office Word and Excel.
• Demonstrated ability to work effectively in a team environment.
• Medical terminology, Cardiovascular terminology, ICD-9, CPT-4 and HCPCS knowledge required
  

*Liaison to the Manager, Finance/Patient Financial Services, all hospitals, all PMG Sites, PHP, , Albuquerque Ambulance, Compliance and all HSL departments in addressing auditing, compliance and training issues and problems.
*Performs quality assurance audits of patient accounts for accuracy of information obtained during and after the admission process which includes but not limited to; patient demographics, complete and accurate insurance information, appropriate authorizations obtained, appropriate coding, accurate charges, identifying compliance and reimbursement related issues and accurate claims submission.
*Responsible for maintaining accurate, complete and timely documentation in electronic or hard copy form.
*Researches to the fullest extent and responds to inquiries and requests daily regarding auditing issues and problems and ad-hoc analysis for all PHS management.
*Identifies and disseminates solutions to audits by developing, implementing, and delivering knowledge, and technical training, for Presbyterian employees.
*Works with assigned business unit managers and staff to determine learning and training needs. Assesses the development and performance needs of the target audience.
*Develops learning and training materials, including participant workbooks, audio-visual materials, and facilitator guides.
*Identifies billing and collection practices that are inconsistent with contractual agreements and Government regulations.
* Summarizes findings with recommendations to Management.
*Identifies training needs regarding existing and new PHS guidelines. Works with Department Manager to ensure that new policies are incorporated.
*Assist with training by reviewing training material, critiquing the training class and communicating trends for re-training needs.
*Gathers and analyzes information to address and resolve business issues for a specific business group.
*Provides information to Management of discrepancies found.
*Maintain clear communication by responding to problems and inquiries via the telephone and e-mail.
*Maintains up-to-date working knowledge of all PHS business areas and IT applications.
*Participate in business unit meetings as an ad-hoc member to communicate trends and obtain up to date information.
*Assists in communicating and training HSL Staff on changes in procedures.
*Performs other functions as required.

We're all about well-being, starting with yours.

Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1200 providers and nearly 3,500 nurses.

Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity

Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. Compensation decisions are dependent upon the facts and circumstances of each offer.
USD $28.36