Billing and Eligibility Application Analyst

Overview

This position reports to the Director of Revenue Cycle and works on revenue cycle improvement, strategic initiative analysis and supports ongoing organizational transformation efforts.  As part of a team, position is responsible for analyzing, maintaining, developing and implementation of the billing software EPIC and the contracted Clearinghouse.

Responsibilities

Principal Duties and Responsibilities (*Essential Functions)

*Analyze and prioritize request for system changes/enhancements.  Identify potential problem areas and recommend optimum approaches.

*Effectively works as a Team member to ensure quality of integration across system modifications. Ensure programs and related components are continuously reliable, available and function as required.

*Ensures proper change control and documentation for upgrades and system modifications are correct and the programs and related components are continuously reliable, available and function as required.

*Participates in the development, implementation and testing of application software, training materials and provides training as needed.

*Review of clearinghouse software to ensure claims are being sent to payer in a timely manner.

Watches for holds, payer rejects, and errors and works with staff to eliminate/reduce them.

*Review of clearinghouse software to minimize errors for automation of registration through real time eligibility. Designs rules, workqueues and reports within the clearinghouse that runs eligibility to compare to the billing software so that areas of discrepancies are identified and worked.

*Establishes new payer and plans which work efficiently with Real Time Eligibility by mapping, creating alerts and identifying trends that show an opportunity for improvement.

*Designs and builds Clearinghouse software for optimum scrubbing of claims from the hospital billing system to ensure CMS, Medicare, and Commercial payers are current on edits being released from both systems (EPIC and Quadax).

*Assists staff with claim issues in order to move claims through the systems and determine if it is a payer, billing system or educational opportunity for improvement.

Performs other duties as needed and/or assigned.

Qualifications

Job Specific (Minimum Qualifications)

Knowledge, Skills, and Abilities

• Knowledge of UB-04 and 1500 billing forms are required.
• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
• Ability to prioritize job functions, work independently and exercise good judgment.
• Must possess good organization/analytical skills and mathematical aptitude.
• Epic Certification in at least: Prelude and Real Time Eligibility.

Education

Bachelors or Associates Degree in Business or Healthcare  Administration, Accounting or a closely related field is Preferred.

Experience

5 yrs of experience in Hospital Billing is Required

5 yrs of experience in EPIC is Required

1 yr of experience in Business Office is Preferred

Certifications and Licensures

EPIC Prelude Certification is Required

EPIC Real Time Eligibility is Required

Model of Care and Conduct

Methodist Hospitals strives for excellence and insists on high standards of conduct and performance in everything we do. Our Model of Care and Conduct is designed to create a positive work environment which Methodist desires for all employees. This is foundational to the high level of patient, family and physician satisfaction we strive for each day. As part of all position’s duties at Methodist Hospitals, all employees are responsible to conduct themselves in accordance with the Model of Care and Conduct and will be evaluated according to these standards of behavior.