Job details
Job type full-time
Full job description
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Job title:
Business systems analyst
Department:
Health system shared services | revenue cycle clinical support
Scope of department;
The research billing office (rbo) is an area within access and revenue cycle management shared services dedicated to serving researchers and health system staff throughout the medical centerThe rbo is responsible for monitoring and improving research /institutional billing processes for the health system to ensure accurate billingThe rbo provides the following services: research rate quotes for the health system (hospital and professional) ; management of the research study master file in ihis; epic build for research billing functionality, research (hospital and professional) and institutional account billing ; oncore rpe and crpc interface to epic, assistance completing research billing compliance forms; submission to medicare for approval of investigational devices; investigational device set-up for the health system, research & hud pre-determination ; management of research related injury billing workflows, education and training for health system institutional billing processes.
Scope of position
The rbo systems analyst is primarily responsible for planning, developing, building, testing and implementing detailed system s build to support the needs of the rboThe systems analysts utilizes their operational knowledge of the rbo business functions to develop workflows and associated system build to complete workflowsThe systems analysts also assist s the manager and director of the rbo in the development, implementation, and evaluation of the rbo and services provided to both internal and external customersThe systems analysts shall work in concert with the manager and director to support operational planning needs to for initiatives such as ensuring compliance requirements are met to preserve the integrity of the osumc finance compliance plan.
Position summary
R esponsible for the analysis, planning, development, building, testing, implementation, follow-up, trouble-shooting and evaluation of business functions and related systems build for research billing office (rbo)Understands the entire research /institutional billing process including; university c linical research management and clinical trial management system (ctms) ; c linical research budgeting; e stimating research rates, access and revenue cycle processes, rbo operations; research operations web application (rowa), rbo website and patient management/accounting systemsThe systems analysts is the rbo administrator for epic research build including interfaces from the ctms, the rbo website , rowa and research billing online learning L ead s staff, complet es research rate requests, review s /analyz es /operationaliz es research functionality in epic , institutional billing, develops/implements policies/procedures, provides education, training, mentoring, creat es /run s /analyz es reports of rbo operations, and completes research pre-determination s .
Serves as liaison and resource to customers ( physicians, researchers, health system staff, department heads , and patients ) on operations.
Duties and responsibilities
60% information systems management
Identifies projects (includes new epic functionality) with scope, required resources, and timelines for rboServes as project manager for functionality working with cross functional teamsFacilitates meetings, task assignment, and issue resolution.
Developer/ administrator of the rbo onesource website.
Developer/administrator of res earch operations web application (rowa); provides education and training; troubleshoots issues with the application; works with application builder to resolve issues.
Developer/administrator of epic research billing functionality including wqs, rules, dnbs, cers, components, system settings, etcBuilds new research and institutional accounts in epic Requires knowledge of the application and functionality (research administration, system definitions, facility/service level profiles, enrollment settings, billing settings, review settings, security classes, cer records, charge router, hospital and professional work queues/rules).
Developer/administrator for oncore to epic rpe and crpc interface s.
Administrator of epic research billing help desk work queue.
Administrator of epic research billing help desk work queue.
Completes workday journal entries for research billing.
Responsible for data courier of build from epic poc to tstResponsible for completing entries in changed control for the movement of the build to prd.
Supports carelink study monitor requests.
Identifies appropriate data elements and runs hcc queries to analyze data for complex research rate requests.
Creates appropriate tools (spreadsheets, databases , graphs, charts, etc.) required to d evelop, implement, and analyzes workflows, programs and systems in regards area needs .
Generates a variety of reports for use by internal and external customersPerforms quantitative and qualitative analyses of the data to determine the status of the rboUtilizes the data to inform appropriate constituencies of status, make operational decisions, and quality improvement.
2 0 % research operations
R eview s research studies to evaluate clinical services and determine hospital and professional resource requirements.
Coordinates with services departments to complete research rate requests.
Gathers all required information (lab packet, compliance forms).
Communicates research rates and new institutional accounts to appropriate personnel.
Schedules appointments for blinded specimen processing.
Subject matter expert on system management of research and institutional billing.
Research billing t rainer responsible for teaching new research staff on research billing responsibilities.
Monitors over 100 work queues in bil ling system for hospital and professional servicesIdentifies when queues are not being worked and resolves.
Monitors other institutional related claims on hold in electronic billing system and delegates as needed Requires an understanding of insurance and reimbursement to be able to troubleshoot issues and offer solutions to edits, rejections, and denials.
Prepares and bills initial and secondary claims using hospital system by understanding, applying 3 rd party rules and regulations (especially for research), and reviews for coding appropriateness
Resolves billing errors on both patient and institutional accounts for hospital and professional.
Reviews/approves/tracks research rate correction requests .
Reviews/approves/tracks accounts to be adjusted and written off.
Reviews, researches and corrects claims errors, disputes, and rejections due to research to resolve and facilitate payment of denied claims
Contacts 3 rd party payers to seek resolution to billing issues or claim rejections .
R eview s new studies to evaluate the research pre-determination requirements.
Assists in preparing research pre-determination templates.
Contacts patient`s insurance payer to verify and begin pre-determination processes.
Submits necessary documentation to payer in order to verify medical necessity of specified services.
Maintains database for all patients requiring pre-determination.
Arranges patient and customer-friendly access to hospital and medical staff services for patients receiving research related services.
Serves as a contact for research pre-determination issues .
Investigates and works to resolve problematic insurance coverage related to out-of-network provider status and policy benefit language that may prevent the patient from receiving the services identified; maintains familiarity with aspects of the patient intake process to facilitate early detection of problems.
Identifies situations when clinical expertise is required to resolve administrative issues and escalates them to the director.
Makes recommendations for ongoing improvement regarding patient communication tools specific to insurance coverage and pre-determination.
Contacts patients as necessary with a focus on customer service ;
Maintains communication and coordination with the health system departments of scheduling, admitting, insurance pre-certification, financial counseling, managed care contracting, clinical areas, patient accounting as well as physicians, principal investigators, and research staff.
Manages research denial tracking log.
Assists with preparing submissions to medicare for approval of investigational device ide studies.
10 % administrative , customer services, and quality assurance responsibilities
Leads, trains and supports rbo staff and research staff .
Creates strong business partnership with managers and others in key positions within the organization.
Directs, develops, and manages data on all research and institutional accounts monitored by the rbo.
Develops standard operating procedures and policies .
Develops and manages rbo required forms.
Articulates the organization’s mission, values, strategies, and priorities.
Provides excellent customer service to internal and external customers.
Serves as a liaison and res ource for institutional billing activitiesDevelops and maintains working relationships with key departments (scheduling, pre-certification, registration, revenue management, finance , college of medicine office of research, ccts, ctmo, ccc cto, office of sponsored programs, research departments ) .
Serve as a training resource in creation of clinical research billing compliance cbl.
Managed car-t medicare/map split billing workflow and created ihis rule to hold and route accounts to rbo.
Draft purchased service agreements for clients.
Kronos backup timekeeping editor.
Performs random and for cause audits of studies for research billing compliance.
Assists staff as needed with complex daily issues .
Identifies area trending and process improvement opportunities .
Responds to customer inquiries in a timely manner .
Manages research billing helpline /email inquiries .
Delegates pending customer service issues to appropriate staff .
Performs other duties as instructed by management .
Organizational expectations
Practices within the medical center ’s policies and procedureAdheres to the mission , vision, and value statements as demonstrated through positive patient/guest relations, positive and effective interactions with staff, and formulating and meeting developmental goals.
Minimum qualifications
For hire:
Bachelors degree or equivalent education/experience; experience in health access program planning.
O rganization and administration skills strongly desired .
K nowledge of and/or experience with health related services , regulatory requirements, quality im provement, cost reduction, current registration & billing policy and procedures as well as scheduling policies and procedures strongly desired .
Experience with excel, access, and powerpoint programs to the point of being able to quickly and succinctly understand new computer processes required.
Experience with healthcare billing including system applications, user training and a strong knowledge of the health insurance industry.
Knowledge of health system operations strongly desired.
E xperience with insurance verification strongly desired .
E xperience with epic strongly desired Proficiency in epic research billing strongly desired.
E xperience in a healthcare setting or physician’ s practice helpful
D emonstrated organizational, writing, and communication skills; computer skills required with experience utilizing
Microsoft office software applications, ihis, capi, idx, and citrix .
Able to demonstrate independence, self-initiative, thoroughness, and attention to detail.
Ongoing :
Demonstrates competency in cognitive and interpersonal skills required to meet essential job functionsRemains current with departmental systems and computer softwareMaintains current knowledge of regulatory changes and trends in the health care environmentAttends continuing education seminars on job-related topics.
Patient population served
Knowledge of growth and development and an understanding of the range of treatments necessary to meet the age specific needs of the patient population served ( check those that apply):
Not applicable: non-patient care title
Xx
Neonates (0 - 6 months)
Adults ( 18 - 64 years)
Children (7 months - 13 years)
Geriatrics (65 + years)
Job relationships
Supervisory responsibility: rbo staff
Contacts: many levels of persons within the osu medical center , and the community including patients , families, medical faculty , health system staff, allied medical professionals within and outside the university community .
Responsible to: manager, research billing office
Physical/visual/mental requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this jobReasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee must be able to:
Ability to organize time and tasks effectively, deal with problems in priority order, and adjust schedules accordingly.
Ability to analyze a situation, problem-solve, develop a strategy, and makes independent decisions, using proper judgment and initiative.
Ability to communicate clearly in order to facilitate the patient care plan or other outcomes.
Ability to move objects weighing up 30 lbsAround the work environment in order to assist in operations .
Work environment
The work environment involves everyday risks or discomforts which requires normal safety precautions typical of such places as offices and meeting rooms ( i.eUse of safe work practices, avoidance of trips and falls, and observance of fire regulations and traffic signs).
Note: the above statements are intended to describe the essential functions and related requirements of persons assigned to this jobThey are not intended as an exhaustive list of all job duties, responsibilities, and requirements.
Additional information:
Location:
Remote location
Position type:
Regular
Scheduled hours:
40
Shift:
First shift
Salary grade:
Health system annual 024
Final candidates are subject to successful completion of a background checkA drug screen or physical may be required during the post offer process.
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