Resource Planning Analyst (HS)

SCOPE OF POSITION:

The Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for managing Clinical Pre-Certification/Pre-Determinations, Retro-Authorizations, Patient Access Program vendors, Criteria review for Value Analysis, Clinical Case Reviews, Complex Billing (Medicare A to B, ASAM) Complex Denials, Clinical Appeals. RCCS is responsible for responding to Government, Commercial and Internal audits. RCCS performs denial data analytics and write-off reporting. RCCS provides extensive reporting to Senior Leadership on these areas. The Health System includes all facility billing for the University Hospital, Ross Heart Hospital, University Hospital East, The Arthur G. James Cancer Hospital, OSU Harding Hospital, Dodd Hall Rehabilitation and Ambulatory Surgery Centers. RCCS interprets payer requirements and develops processes to obtain clinical precertification and aggressive appeal arguments in collaboration with physicians. Claims are reviewed and edited to ensure accurate billing. Information Technology and Reporting are leveraged to efficiently manage the extensive volume of claim activity to ensure timely processing of claims.

RCCS is integral to the support of a successful/healthy and compliant revenue cycle. It is responsible for bringing in cash to support the financial bottom line, keeping days in Accounts Receivable low, maintaining efficient/effective operations, and supporting patient-friendly experiences.

The Resource Planning Analyst (RPA) provides administrative and analytical support to the Director, Management team in RCCS, and nursing staff.

The Resource Planning Analyst (RPA) position is responsible for resolving issues related to authorizations, billing, and compliance within the revenue cycle for OSU Health System through quantitative and qualitative analysis techniques. The RPA supports OSU Health System in meeting the objectives of a successful and compliant revenue cycle by increasing cash on hand, lowering AR days, and lowering rejections/denials. This position provides support, intervention, and follow-up on a variety of processes that impact the revenue cycle including authorization review, analysis, and combining/uncombining accounts. The overall goal of the department is to ensure compliance with billing regulations yet also ensure payment.

POSITION SUMMARY:

The Resource Planning Analyst is responsible for a wide variety of functions. Daily functions revolve around analyzing and resolving issues with accounts that involve authorization, billing, and compliance. This position is responsible for independently monitoring and ensuring all in-patient accounts are billed with correct utilization review data to prevent denials. Applies payer policies and procedures to denial information.

Responsible for reviewing accounts with various claim errors that require higher-level review. This can include claims with admission or discharge date discrepancies, admission order timing issues, or various other regulatory compliance issues. Responsible for interdepartmental/intradepartmental communication and process improvement throughout the revenue cycle. Must become competent in all available systems where revenue cycle information is held.

MINIMUM QUALIFICATIONS:

Qualified candidates should have a bachelors degree in healthcare administration or an appropriate closely related field. Knowledge of all aspects of the revenue cycle is considered extremely helpful: (scheduling, patient flow through the system for inpatient and outpatient, patient placement, charge entry, and billing). Operational knowledge of the primary revenue cycle systems (EPIC) along with systems processes and design preferred. Experience with Excel, Access, OneNote, and PowerPoint is required. The ability to synthesize information and concisely communicate either verbally or in writing is essential. Ability to work well under pressure. Ability to demonstrate independence, self-initiative, thoroughness, and attention to detail.