Operations Analyst - Medical Imaging Group
- Job ID 14945
- Date posted 12/02/2019
*Minimum seven years experience in health care required with at least three years in medical imaging.
Develops and maintains best practices, processes, procedures, protocols and creates performance presentations to use when reviewing performance with others. Responsible for assessing operational and financial objectives and performance metrics in all areas of the business and executing upon actions identified during analysis. Additionally, the analyst will be responsible for understanding all customers’ needs and serve as a subject matter expert in imaging.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Gather, interpret, and translate customer needs and business problems into requirements that facilitate application development.
- Analyze and assess data and product performance to identify issues and ensure appropriate prioritization and compliance.
- Build reporting solutions and develop/enhance existing scorecards, dashboards and other key reports that are to be utilized by management to monitor performance and communicate performance to the centers.
- Develop and maintain standards to measure the effectiveness of all aspects of the imaging business, including statistical data for monthly reports.
- Integrate and analyze data from multiple data sources, determine root cause; summarize and prepare monthly materials for discussions with centers and home office leadership team.
- Audit and analyze data to verify quality and data integrity.
- Provide feedback regarding issues and/or anomalies found during analysis to ensure proper communication both internally and externally.
- Serve as resource for special projects and priority assignments as needs are identified during the analysis process.
- Utilize all duties and responsibilities above and below to create best practices, thorough documentation and a training and education program based off of data/metrics to standardize/streamline imaging operations across the enterprise.
- Prioritize and manage multiple tasks to meet deadlines.
OTHER DUTIES AND RESPONSIBILITIES:
Billing and Revenue Cycle Responsibilities
- Evaluate Gross Charges to ensure that the preferred Gross Charge/Billed Amounts are loaded in all systems to ensure that Contractual Adjustments remain in-line with industry standards and Medical Imaging Group (MIG) preference.
- Collaboration with Managed Care Team on insurance contracting to create, maintain and own the Medical Imaging Group’s comprehensive Charge Description Master (CDM), cash-pay rates and fee schedule worksheets.
- Monitors government and commercial payers for updates and changes to billing and/or regulatory charge master requirements. Communicates and educates clinical and administrative staff on any actions required to comply with new regulations.
- Processes CDM additions, deletions and change requests while maintaining compliance with local, state and federal regulatory agencies.
- Maintains all payor fee schedules in all systems to ensure that changes are loaded prior to the effective date of rate change.
- Performs detailed reviews (at least quarterly) of the CDM and CPT/HCPCS/Diagnosis Code (ICD-10)/LCD/NCD changes and updates them accordingly in Fuji, Imagine, IDS, Availity and other systems by working with vendors, 3rd parties and MIG Operations.
- Review Regulatory and Compliance Communications, applicable CMS transmittals, Local Coverage Decisions (LCD) and National Coverage Decisions (NCD). Assess impact to Revenue Integrity procedures and implement changes as needed.
- Performs in-depth troubleshooting and root cause analyses to identify issues, create solutions and implement action plans.
- Responsible for creating, reviewing and updating Policies, Procedures, Protocols and Forms along with interpreting them and teaching staff how to use them.
- Provides assistance in the design phase, providing project management to new integrations, and providing day-to-day ongoing system support and meeting the needs of the imaging centers and Medical Imaging Group.
- Provide support and guidance for all staff regarding patient flow, cost per patient visit, general efficiency of operations, patient collections and accuracy of data entry for claims submitted to central business office, etc.
- Communicates company directives and instructions to staff and imaging leadership and is responsible for implementation and/or follow-through.
- Incorporates feedback from all customers, compiles and analyzes support data, and recommends procedural and educational changes as appropriate.
- Education: Bachelor’s degree in Accounting, Finance, Healthcare Administration or Business Administration or ten years of applicable healthcare experience.
- Experience (Type & Length): Minimum seven years in health care with at least three years in medical imaging
- Experience with chargemaster maintenance and proficient knowledge of chargemaster components
- Software/Hardware: Proficient in using Microsoft Excel, PowerPoint and Word.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.Tenet participates in the E-Verify program. Follow the link below for additional information.