RCM BA

Consultant Technical Analyst - Revenue Cycle and Claims
Job Summary: o Works with stakeholders to discover, clarify, and document current and future data needs o Performs mapping of revenue cycle, clinical and claims data to a normalized data model. o Serves as a subject matter expert on the revenue cycle data domains such as Registration, Scheduling, Accounting and Billing, Cost Accounting and Claims o Builds data concepts to support Revenue Cycle and Claims use cases o Serves as a key resource for an assigned customer area to understand and explain business and technical issues and to provide viable technology solutions. Responsibilities:

• Act as a quality consultant and subject matter expert, performing

testing and validation of the mapping of data elements to standards

• Collaborates with technical resources to perform root cause analysis

and complete remediation of data quality issues

• Works with customers to clarify and plan for their current and future

technology needs. Determines and maps existing business
processes/functions and recommends changes required to fit a tightly integrated system.

• Designs and implements projects requiring systems integration, small

teams and multiple technical platforms.

• Conducts Return on Investment (ROI) and other financial analysis to

support project funding/prioritization.

• Collaborates on driving improvement activities to achieve department

and organizational goals.

• Coordinates with functional team to assure consistency and

optimization of overall work product

• Assumes a proactive role in driving improvement activities to achieve

department and organizational goals to deliver value.

• Maintains current knowledge of industry and business process trends

and is able to apply that knowledge to existing business processes.

• Provides subject-matter expertise of Health Ministry processes, policies

and requirements in support of functional area process design, testing
and implementation

• Identifies opportunities for process improvement and makes

recommendations that lead to improvements

• Monitors task assignments to ensure they are performed on schedule,

within intended scope and to a defined level of quality.

• Escalates process and project issues that cannot be resolved

Experience:

• Prior experience working as a Revenue Cycle analyst in the Healthcare

system.

• Must have a working knowledge of relational databases/database

structures, SQL expertise desired

• Must have a strong understanding of data collected and used in EMRs,

Revenue Cycle and Patient Accounting Systems.

• Knowledge and experience with ambulatory and acute clinical, billing

and claims workflows and clinical information systems.

• Bachelor or Masters degree in related health or finance field ex

informatics or bioinformatics.

• Complexity of work: Within the scope of job, requires critical thinking

skills, decisive judgment and the ability to work with minimal
supervision. Must be able to work in a stressful environment.

• 5 years of experience preferred