Childrens National Medical Center Senior Business Operations Analyst in United States

As the nation's children's hospital, the mission of Children's National Medical Center is to excel in Care, Advocacy, Research and Education.

We accomplish this through:

•Providing a quality health care experience for our patients and families.

•Improving health outcomes for children regionally, nationally, and internationally.

•Leading the creation of innovative solutions to pediatric health challenges.

Position Summary

Responsible for research and reporting of data related to reimbursement reductions, delays, and non-payment. Serve as the primary liaison between department leadership and/or physicians and the revenue cycle. Meet with department leadership and/or physicians to present data, root cause and develop action plans. Responsible for ensuring solutions implemented and goals achieved. Reports PI initiatives & results. Monitor/identify CMS & payor rule changes & key stakeholders to ensure compliance. Serve as the primary support to Reimbursement & Collection Manager and VP of Revenue Cycle.

Minimum Education

Bachelor's Degree

Minimum Work Experience

5 years Specific Requirements and Preferences At least 5 years of related patient accounting experience required, especially related to denial mitigation, root cause analysis and/or Physician Liaison. Experience in developing and presenting data supported analysis findings to key stakeholders required. Previous experience in health care is highly desirable, including experience with hospital/physician information and patient accounting information systems.

Required Skills/Knowledge

Proven analytical skills including ability to make recommendations based on financial analyses. Excellent PC skills including advanced skill proficiency in Access and Excel spreadsheet analysis. Ability to work in a team environment with other analysts, managers, and physicians. Proficiency in presentation of analytical results. Excellent working knowledge of coding & NCCI edits. Demonstrated knowledge of managed care payer requirements in an acute/physician setting. Demonstrated ability to facilitate team or group activities. Excellent verbal and written communication skills. Demonstrated ability to be flexible and to prioritize workload & decision-making skills. Ability to train clinical staff on new technologies and processes, and to analyze workflow for process improvement. Strong organizational and coordination skills required.

Functional Accountabilities

Liaison and Support for Stakeholders

  1. Appropriately engage and involve key accountable stakeholders in a collaborative manner.
  2. Serve as primary support for Reimbursement & Billing Manager for denial workgroup; provide presentation & findings.
  3. Research payer & CMS policies related to revenue cycle; identify & stakeholders of required changes; track and ensure completions.

Data Analysis and Issue Resolution

  1. Manage matrix of issues & resolutions including accountable stakeholders; ensure results and escalate issues as appropriate; regularly report updates and challenges to manager.
  2. Conduct root cause analysis of issues reducing reimbursement & slowing payment cycle. Identify key issues and assist in tracking, trending and reporting.
  3. Present data and analysis, clearly, to all levels of staff, management &/or physicians.
  4. Meet with department leadership &/or physicians to review issues and develop action plans.
  5. Assist in development of solutions, training & education to resolve issues and share data with staff and management.
  6. Assist with appeal submission and follow up when necessary to ensure deadlines are met; ensure maximum recovery of reduced reimbursement.

Performance Improvement

  1. Understand managed care contracting & reimbursement schemes (Prof /Tech) as well as payer requirements, reimbursement policies & clinical policy bulletins and apply principles to improve performance.
  2. Apply CMS reimbursement rules to operation to drive improved performance.
  3. Develop knowledge of internal billing systems & edits and make recommendations to mitigate denials.
  4. Develop detailed knowledge of internal billing coding and CDM process to identify breakdowns and resolutions.

Staff Competencies

Organizational Commitment/Identification

  1. Partner in the mission and upholds the core principles of the organization
  2. Committed to diversity and recognizes value of cultural/ ethnic differences
  3. Demonstrate personal and professional integrity
  4. Maintain confidentiality at all times

Customer Service

  1. Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

  1. Demonstrate collaborative and respectful behavior
  2. Partner with all team members to achieve goals
  3. Receptive to others' ideas and opinions

Performance Improvement/Problem-solving

  1. Contribute to a positive work environment
  2. Demonstrate flexibility and willingness to change
  3. Identify opportunities to improve clinical and administrative processes
  4. Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

  1. Use resources efficiently
  2. Search for less costly ways of doing things

Safety

  1. Speak up when team members appear to exhibit unsafe behavior or performance
  2. Continuously validate and verify information needed for decision making or documentation
  3. Stop in the face of uncertainty and takes time to resolve the situation
  4. Demonstrate accurate, clear and timely verbal and written communication
  5. Actively promote safety for patients, families, visitors and co-workers
  6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities