Revenue Cycle Business Partner I

BMC Company 100; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

BMC Company 100 is seeking a Revenue Cycle Business Partner I to support hospital and professional billing processes. Under supervision, you will analyze revenue cycle data, prepare reports, and collaborate with insurers and vendors to resolve claim adjudication issues.

You will monitor payer contracts and ensure timely submission and payment of claims while upholding HIPAA and billing regulations. You will also contribute to maintaining quality standards and supporting the Revenue Cycle team in

Qualifications

• Experience with revenue cycle data analysis and KPI reporting.
• Familiarity with Epic and billing systems.
• Knowledge of Medicare/Medicaid policies and RAC requirements.

Responsibilities

• Analyze revenue cycle data to identify trends and opportunities for process improvement.
• Generate reports and dashboards to track billing KPIs and reimbursement.
• Resolve claim adjudication issues with payers and vendors; monitor follow-up on denials.
• Interact with insurance payers, government agencies, patients, and other stakeholders to gather information.
• Ensure timely submission and payment of claims and maintain compliance with regulations.

Skills

Data analysis

Billing & reimbursements

Reporting & dashboards

Communication

Tools

Epic

Clearinghouse

Job description

POSITION SUMMARY

Under supervision of a Senior Manager of Vendor Management, the Revenue Cycle Business Partner I plays a crucial role in supporting revenue operations within the organization. This position involves a combination of administrative and analytical tasks to ensure accurate billing, timely reimbursement, and compliance with regulatory requirements for Hospital and Professional claims. This includes claim correction, submission, and billing up activities, including interacting with insurance payers and third party vendors to resolve claim adjudication issues. This position will be responsible for working billing tasks of moderate complexity, including billing activities requiring insight in to claim processes and follow up activities requiring understandings of payer contracts. The individual will serve as a knowledge resource to other staff within the Revenue Cycle Department. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations and to ensure the accurate and timely submission and subsequent payment of all claims.

Position: Revenue Cycle Business Partner I
Department: PFS Administration
Schedule: Full Time, Quincy MA

ESSENTIAL RESPONSIBILITIES / DUTIES

• Compile, analyze, and interpret revenue cycle data to identify trends, patterns, and opportunities for process improvement.
• Generate regular reports and dashboards to track key performance indicators (KPIs) related to billing, collections, and reimbursement.
• Provide insights and recommendations based on data analysis to optimize revenue cycle performance and efficiency
• Review and collaborate with vendors to handle late charges, including submitting late charge claims or late replacement claims with the appropriate Type of Bill (TOB)
• Participate in internal audits and quality assurance activities to maintain compliance and integrity of revenue cycle processes
• Reviews, reconciles, and makes necessary corrections to edits received from BMC's clearinghouse. Some focus will be dedicated to complex accounts or payers
• Proactively and professionally contacts insurance companies, government agencies, patients, and other customers via phone, email, or paper correspondences to gather or provide information required for the successful submission and resubmission of claims.
• Utilizes full range of information and tools available on insurance and third party websites to gather required information
• Interacts professionally with customers to answer billing and payment questions
• Documents all correspondence and conversations with insurance companies, government agencies, patients, and other customers on patient's account or phone log as appropriate
• Review no-response work queues with third party payer vendor to aid with resolving outstanding claims
• Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching payer remittance advice. Some focus will be dedicated to complex accounts or payers
• Conducts follow up research on underpaid claims to review contract discrepancy. Escalates and forwards any Epic or legacy contract management issues encountered to supervisors or the appropriate department as directed
• Reviews appropriateness of account balances and resolve discrepancies as necessary, including attaching documentation, amending coverage/patient/encounter/provider/facility data, gathering additional information requests, and resubmitting corrected claims
• Forwards denials to appropriate Epic work queue for other functional expertise, outsourced business partner where required
• Stays informed about and interprets updates in Medicare, Medicaid, and Health Safety Net policies; monitors changes in RAC (Recovery Audit Contractor) requirements and raises any potential concerns.
• Monitor and provide updates on outstanding accounts receivable balances in Epic for insurance, self-pay, and credits to ensure timely resolution.
• Ability to report on all changes that affect the workgroup to Manager and other appropriate management within the Revenue Cycle operations team.
• Advises management of any potential compliance issues immediately
• Adheres to and maintains an up to date knowledge of billing and claim processing regulations, policies, and procedures
• Adheres to and maintains an up to date knowledge of all relevant state and federal laws regarding medical billing, including HIPAA privacy and security regulations
• Adheres to and maintains an up to date knowledge of all relevant BMC's policies and procedures, including confidentiality policies and sexual harassment policies
• Attends in-services and payer seminars and keeps abreast of current issues affecting reimbursement, billing and collection. Maintains files and documentation of current regulations and guidelines.

Must adhere to all of BMC's RESPECT behavioral standards