Revenue Cycle Analyst (Adjustments)

Columbia University; New York (NY); Remote; USD 65,000 - 78,000; Full time

Job summary

An established industry player seeks a dedicated Adjustment Analyst to enhance operational efficiency within the Clinical Revenue Office. This role involves overseeing adjustment processes, ensuring compliance with payer guidelines, and collaborating with various teams to resolve discrepancies. The successful candidate will leverage their expertise in revenue cycle management and analytical skills to drive improvements and maintain financial integrity. Join a forward-thinking institution committed to excellence and innovation in healthcare finance, where your contributions will make a significant impact.

Qualifications

• 3+ years of experience in revenue cycle management or billing.
• Strong knowledge of payer guidelines and healthcare finance.

Responsibilities

• Oversee adjustment requests and ensure compliance with payer guidelines.
• Analyze trends in adjustments to identify root causes and recommend strategies.

Skills

Revenue Cycle Management

Analytical Skills

Problem Solving

Communication Skills

Attention to Detail

Education

Bachelor's Degree

Tools

Microsoft Office

EPIC

GE/IDX Systems

Job description

Job Type: Officer of Administration
Regular/Temporary: Regular
Hours Per Week: 35
Standard Work Schedule: 9AM-5PM, M-F
Salary Range: $65,000.00-$78,000.00

Position Summary

The Adjustment Analyst is responsible for overseeing adjustment processes within the Clinical Revenue Office, ensuring accurate and timely resolution of adjustment requests while analyzing the root cause of adjustments to enhance operational efficiency and minimize revenue loss. This role manages the intake, processing, and resolution of adjustment requests, and collaborates with the Adjustment & Payer Escalation Manager to implement process improvements. The Adjustment Analyst plays a key role in maintaining compliance, enhancing operational efficiency, and supporting the overall financial integrity of the revenue cycle.

Responsibilities

Operations Management

• Oversee the daily execution of adjustment requests, ensuring accurate adjustment code used, analysis, and documentation are in line with payer guidelines and institutional policies.


• Perform reviews and validate adjustments to ensure all due diligence including payment corrections, are processed accurately and efficiently.


• Manage adjustment workflows, prioritizing tasks to meet deadlines and maintain productivity standards while ensuring compliance with established protocols.


• Collaboration with the Adjustment & Payer Escalation Manager in developing and refining workflows and procedures to enhance the efficiency and accuracy of adjustment processes.


• Provide expert guidance by analyzing complex adjustment cases, working closely with internal departments and external payers to resolve discrepancies and maintain payment integrity.


• Conduct quality reviews to ensure adjustment activities meet accuracy and compliance standards, implementing corrective actions as needed.


• Serve as the primary point of contact for escalated adjustment issues, coordinating with internal teams and payers to resolve discrepancies promptly and accurately.


• Analyze trends in adjustments to identify root causes of recurring issues, recommending corrective strategies to the Adjustment & Payer Escalation Manager.


• Manage the resolution of high-complexity adjustment cases, ensuring thorough documentation and effective communication with all stakeholders.


• Provide feedback and insights to the adjustment team and management on areas needing improvement, focusing on enhancing accuracy and efficiency in adjustment activities.

Compliance

• Ensure all adjustment activities comply with payer contracts, institutional policies, and regulatory requirements, including HIPAA and CMS guidelines.


• Supervise adjustment processes to maintain adherence to quality and compliance standards, conducting regular reviews to identify areas for improvement.


• Support internal and external audit processes, preparing documentation, responding to findings, and implementing corrective actions as necessary.


• Stay informed on industry regulations, payer policies, and best practices, ensuring adjustment procedures are updated to meet evolving standards.

Reporting and Analysis

• Track and report on adjustment performance metrics, including accuracy, resolution rates, and trends, providing updates to the Adjustment & Payer Escalation Manager.


• Utilize data analysis to identify opportunities for operational improvements and contribute to strategic initiatives aimed at enhancing adjustment accuracy and efficiency.


• Generate detailed reports on adjustment activities, summarizing key trends, issues, and recommendations for management review.

People

• Collaborate with billing, coding, and reimbursement teams to address adjustment-related issues, supporting overall revenue cycle operations.


• Communicate effectively with internal stakeholders, providing updates on adjustment activities and contributing insights to improve payment processes.


• Represent the adjustment function in departmental meetings, committees, and task forces as assigned, advocating for process improvements and sharing best practices.

Please note: While this position is primarily remote, candidates must be in a Columbia University approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the responsibility of the employee and will not be reimbursed by the company.

Minimum Qualifications

• Bachelor's degree or equivalent in education and experience.


• Minimum of 3 years of experience in revenue cycle management, billing, or adjustments, and denials with demonstrated expertise in managing complex payment discrepancies.


• Strong knowledge of adjustment processes, payer guidelines, and healthcare finance, particularly in the context of payment variances.


• Proven problem-solving and analytical skills, with a strong attention to detail and the ability to manage complex adjustment issues.


• Excellent communication and interpersonal skills, with the ability to interact effectively with internal teams and external payers.


• Proficiency in Microsoft Office (Word, Excel) and experience with billing and adjustment software, including EPIC and GE/IDX systems.


• Ability to work independently, manage multiple tasks, and prioritize responsibilities in a fast-paced environment.

Preferred Qualifications

• Experience working in a central billing office or large healthcare system.


• Familiarity with payer contract management and quality assurance processes.


• Advanced proficiency in data analysis tools and experience generating reports for management.

Competencies

Patient Facing Competencies

Minimum Proficiency Level

Accountability & Self-Management

Level 3 - Intermediate

Adaptability to Change & Learning Agility

Level 2 - Basic

Communication

Level 2 - Basic

Customer Service & Patient Centered

Level 3 - Intermediate

Emotional Intelligence

Level 2 - Basic

Problem Solving & Decision Making

Level 3 - Intermediate

Productivity & Time Management

Level 3 - Intermediate

Teamwork & Collaboration

Level 2 - Basic

Quality, Patient & Workplace Safety

Level 3 - Intermediate

Leadership Competencies

Minimum Proficiency Level

Business Acumen & Vision Driver

Performance Management

Level 2 - Basic

Innovation & Organizational Development

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.