Clinical Revenue Management Analyst I

Overview:

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Under the general direction of the Manager Clinical Revenue Management (CRM), Diagnostic Related Group Denials (DRG), Utilization Review (UR), the Clinical Revenue Management Analyst (CRMA) performs a wide range of system wide clinical revenue management activities to support the CRM Department.

EEO/AA/Disability/Veteran

Responsibilities:

• Creates daily assignments Monday through Friday for the department nurses
  • Assigns initial IP reviews per tasking protocol.
  • Places identified retro reviews in an electronic folder
  • Notifies CRM staff daily via e-mail regarding their review volume.
  • Ongoing education to staff regarding tasking protocols and how to utilize the bed day screen as a tickler for scheduling future reviews.
  • Audits both patient lists and application of bed days then meets to reeducate staff 1:1 on an ad hoc basis with specific examples.
• Assigns inpatient case reviews and retrospective reviews to department nurses Monday through Friday based on case request payor volumes and tasks case reviews by priority.
  • Maintains accurate log of denials and appeal decisions.
  • Enters pending activity, authorizations and denials in Epic.
• Ensures timely processing of inpatient CRM reviews to obtain maximum payor reimbursement for care provided for all payors.
  • Contacts payor to follow through on stays of incomplete case reviews.
  • Maintains an open dialogue with all payer.
• Participates in payor communications to follow through on inpatient stays with incomplete case reviews.
• Maintains an open dialogue with payor representatives in matters of denials and retrospective review requests.
• Completes required payor appeal request forms timely prior to CRM nurse appeal letter submission.
• Coordinates payor and managed care organization follow up related to outstanding denials and identified payor issues.
• Responsible for reviewing key departmental statistical reports and maintains dashboards.
• Ensures appropriate Neonatal Intensive Care Unit (NICU) leveling codes pre-bill to assist with accurate billing status and appropriate reimbursement for care provided.
  • Assembles and compiles standardized data from established sources.
  • Assembles and compiles data in accordance with established department procedures.
  • Assembles and compiles data within established timeframe
• Manages payor portals for inpatient reconsideration correspondence
  • Appropriately takes messages as necessary and ensures prompt delivery to the appropriate recipient.
• Coordinates payor Epic Care Link access to the electronic medical record based on payor contract
  • Manages new Epic Care Link access requests and ensures payor forms are submitted with correct information.
  • Manages Epic Care Link access payor issues including expired or inactive status
  • Communicates with designated payor Epic Care Link Sponsor as needed.
• Consistently communicates with the department nurses regarding daily assignments, review volumes, and payor communications and/or issues
• Identifies payor trends and barriers and reports issues to department leadership.
• Participates in Connecticut Behavioral Health (CT-BHP/Carelon) authorization process for both initial and concurrent inpatient authorizations.
• Coordinates the maintenance and tracking of key indicators via automated reporting.
• Coordinates department scheduling and paid time off requests as needed
• Participates in monthly staff meetings, staff education and orientation as needed.
• Performs other duties as assigned or directed to ensure smooth operation of the department
• Works on project work as assigned by the Manager

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Qualifications:

EDUCATION

• Bachelors Degree required.
• Work requires communication, analytical, and auditing skills generally acquired through completion of a Bachelors Degree program in Health Information Management, Business or another related field.

EXPERIENCE

• Minimum of two (2) years experience reviewing, auditing, and/or analyzing electronic medical records in an acute healthcare setting preferred.
• Advanced skills using Microsoft Office products required.
• Experience with Epic strongly preferred.
• Ability to review and navigate electronic medical records.

SPECIAL SKILLS

• Excellent communication and organization skills.
• Ability to adapt to varying department needs and able to prioritize multiple tasks appropriately.
• Working knowledge of third party and prospective payment systems preferred.
• Experience working with Microsoft Office including Word, Excel, Teams, and Power Point.
• Experience working with EPIC strongly preferred.