Recovery Centers of America at King of Prussia
Position Overview: The Operations Revenue Cycle Analyst functions out of the Recovery Centers of America (RCA) Corporate office and is responsible for collaborating with all sites (inpatient, outpatient, and MAT) to provide support, identify operational gaps, ensure operational processes are being followed, and implement new or adjusted processes/protocols impacting revenue cycle.
Overseeing the day to day activity and structure of the site Financial Counselors, Utilization Review Departments, and Outpatient/MAT UR functions will be under the purview of the Operations Revenue Cycle Analyst. This includes but is not limited to providing direct supervision to Outpatient UR staff and MAT UR staff. The Operations Revenue Cycle Analyst will collaborate with RCA Corporate teams including Finance, Patient Accounts, and the Mission Center to develop, document, train, and provide oversight of operational processes and procedures to maintain fidelity and standardization organizationally.
A major focus of the Operations Revenue Cycle Analyst includes ensuring all RCA programs are maximizing their capacity to treat patients and assist with growing the census by collaboratively developing strategies to increase length of stay for current patients. Additionally, this position is required to monitor adherence to existing RCA operational protocols related to program compliance with accurate data entry in the Electronic Health Record (EHR), insurance authorizations, census management, and financial options and assistance.
The Operations Revenue Cycle Analyst will work closely with both Corporate teams and RCA site Leadership/Management to ensure all RCA programs are following all protocols and policies impacting revenue cycle and ultimately to ensure the patient treatment experience is aligned with the RCA Mission at all RCA programs. This position will assist with training or auditing needs based on operational policies and procedures and/or quality assurance plan of corrections.
- Thoroughly understand processes, policies, and procedures related to overall facility operations for all RCA programs and levels of care.
- Maintain updated documentation of operational workflows for Utilization Review, Census Management, Financial Counselors, Admissions, and Finance/Billing.
- Facilitate support in monitoring of Cobra, Chart Appeal, Patient Financial Responsibility Collections, and any other metrics/functions associated with revenue cycle.
- Provide summaries of status of all identified areas of revenue cycle impact and present solutions for any issues identified. Manage process of resulting identified solutions.
- Provide weekly or biweekly supervision meetings (dependent on relevant issues) to Financial Counselors, Utilization Review Managers, and OP UR staff.
- Ensure all operational processes and workflows are completed accurately in order to ensure proper billing.
- Provide reliable trending analysis of current and past data including, but not limited to, length of stay and days authorized by specific insurance companies, denied days and appeals by specific insurance companies.
- Consistently work to assist with the development of new and innovative systems/processes to help maximize patient days.
- Exhibit knowledge of all continuums of care, including admission assessment and continued stay criteria.
- Share knowledge and experience working with in-network and out-of-network benefits to help maximize patient days.
- Validate all efforts to obtain authorization, authorized days, and details related to insurance denial and appeal efforts are documented clearly and thoroughly in the EHR.
- Provide insight and information at the request of treatment team members and communicate all utilization challenges or concerns that may compromise patient’s treatment immediately.
- Ensure treatment teams are working closely with insurance carriers to provide accurate information and obtain authorization of coverage.
- Conduct internal reviews of operational processes impacting revenue cycle as needed in collaboration with supervisor and identify areas in need of improvement.
- Articulate results of internal reviews and collaborate with other RCA Departments to establish plans for improvement.
- Provide support to Operations Team to ensure RCA mission, goals, and objectives are achieved.
- Work harmoniously with colleagues, supporting colleagues as appropriate and balancing individual and team goals
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Education and Experience:
- Bachelor’s degree and 3+ years’ related experience
- Excellent verbal and written communication skills.
- Excellent organizational skills with the ability to prioritize workload
- Proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
- Customer Service: Demonstrates concern for meeting internal and external customers’ needs in a manner that provides satisfaction for the customer within the resources that can be made available.
- Problem Solving: Identifies problems, involves others in seeking solutions, conducts appropriate analysis, searches for best solutions; responds quickly on new challenges.
- Communication: Comfortable using a broad range of communication to different audiences in diverse solutions.
- Project Management: Coordinates the diverse components of the projects by balancing scope, time, cost, and quality.
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or outpatient facilities. They spend much of their time on their feet, actively working with patients.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected
It is the policy of Recovery Centers of America (RCA) to ensure equal employment opportunity without discrimination or harassment on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, age, disability, marital status, citizenship, genetic information, or any other characteristic protected by law.