PFS Receivable Analyst

Division:Eskenazi Health

Sub-Division: Hospital

Req ID: 26286

Schedule: Full Time

Shift: Days

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

FLSA Status

Non-Exempt

Job Role Summary

The PFS Receivable Analyst provides timely and accurate billing to facilitate optimized reimbursement, research and performance improvement initiatives. This includes the verification of billing data for accuracy and completeness, following regulatory requirements, and in order to resolve edits or exceptions detected during system processing of the claim in the patient accounting system, claim editing system or the payer, reviewing the medical record, facility protocol, other applicable documentation, and the understanding of payer denials, appeals process, and credit balances.

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Healths mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Healths values of Professionalism, Respect, Innovation, Development and Excellence
• Responsible for the management and effective resolution of assigned high balance patient accounts to ensure appropriate cash flow is maintained, and patient satisfaction with administrative functions at Eskenazi Health are consistently positive; ensures timeframes are maintained according to Eskenazi Health policies and procedures, federal and state statutes, and payers claim filing timelines
• Responsible for the resolution of credit balances that have an outstanding high balance for hospital accounts
• Troubleshoots current problems, anticipates potential problems and communicates regularly with Revenue Cycle Management team to clarify receivable issues and to resolve immediate problems
• Collaborates with internal departments regarding registration, prior authorizations and/or insurance issues
• Serves as a resource to other departments to resolve problems and expedite billing and collection processes
• Analyzes standard system reports to ensure timely and accurate data processing
• Answers e-mails and voicemails on a timely basis
• Responsible for identifying and trending payer rejections and denials; implements system process improvements to prevent future rejections and denials
• Coordinates with management and system support to identify opportunities to improve system automated process based on payer guidelines and regulations
• Keeps up to date on account billing and collection rules and regulations, contract terms and conditions with regards to timely filing and service pre-certifications and authorizations
• Works efficiently under pressure, acts independently and accepts responsibility for decisions
• Provides coaching and mentoring to billing and follow up team members
• Participates in monthly staff meetings to educate new payer habits and etc. as needed
• Acts as liaison between department and division
• Meets with insurance company representative to ensure positive and productive relationships
• Completes payer appeals based on under payment, timely filing, medical necessity and prior authorizations
• Works with management when contract variances are identified

Job Requirements

• Associate degree in business-related field preferred
• Five years of accounts receivable experience in a hospital billing environment may be accepted in lieu of formal education

Knowledge, Skills & Abilities

• Knowledge of reimbursement procedures, provider coverage, complex state and federal regulations and policies, and Eskenazi Health procedures and policies
• Ability to utilize support systems such as Epic, Onbase, nThrive, and/or other software applications
• Excellent verbal and written communication and organizational skills
• Extensive knowledge of and ability to research and identity payer billing and reimbursement guidelines
• Ability to behave professionally and take team-oriented, solution-driven approaches to problem solving for all types of issues; high level of ethical behavior
• Ability to complete tasks within given timeframes, remaining productive and goal-oriented
• Ability to troubleshoot errors and resolve within a reasonable amount of time
• Must be detail-oriented with the ability to multitask
• Knowledge of PC applications such as MS Word and MS Excel; ability to learn software quickly and interpret instruction manuals
• Knowledge of Epic Patient Accounting system
• Ability to use computer 10-key entry and operate a calculator

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the first verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.