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Responsible for design, development and testing of reports using innovative techniques, analyzing data from various sources and systems. Prepare accurate data analysis in order to communicate with regulatory agencies, contracted payers and internal leadership. Recommend and implement technical solutions to assist in planning, streamlining and decision making. Maximize reimbursement by analyzing contract variances, new technology, denial trending, payment variance trending and regulatory changes. Build and maintain complex reimbursement contracts within our patient accounting system which have a direct impact on our financial bottom line. Build and maintain advanced Microsoft Excel contract models in order to meet the functional needs of staff and streamline process flow. Possesses a high level of technical, analytical and critical thinking skills in order to access various internal and government systems. Continuous learning of frequent changes to payer reimbursement regulations is critical. Use of performance improvement, project management and technology skills will be employed to work with all levels of WVUHS management.
Job Description
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor’s degree in Business Management/Business Administration or Hospital Administration or related field and two (2) years of experience in data analysis and/or health care planning background OR High school diploma (or equivalent) and six (6) years of experience in data analysis and/or health care planning background
2. EPIC Contracting Certification within in one year of hire, with certification completion within four months of formal training
completion.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Healthcare experience
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Business Requirements, Process Analysis and Report Writing: Develops reports independently and analyzes data for appropriate outcomes.
2. Ensures proper knowledge and usage of developed tools and reports are satisfactory with end user.
3. Makes suggestions for problem solving and workflow enhancement as it relates to Patient Financial Services.
4. Maintain and continually advance report writing skills within, EPIC Reporting Workbench, WEBI and other systems as necessary.Maintain and continually improve technical skills needed to write PC programs, spreadsheet macros and design data base structures to produce and analyze reports.
5. Provides thorough financial and statistical analysis of data to support sound decision making as it relates to workflow and contracting outcomes.
6. Collaboratively interacts with Information Technology to further enhance reporting needs of department.
7. Maintain relationships with various departments such as; Patient Access, Financial Services, West Virginia United Insurance Services, Information Technology and Decision Support in order to support business needs and project collaboration.
8. Must remain current with how information is collected, maintained and reported in all key systems, while continuing to develop analysis opportunities currently not being used.
9. Implement and maintain complex Contract Management tools such EPIC Contract Maintenance and advanced Excel Contract Modeling.
10. Continually analyze data for missed opportunities for increased revenue.Provide monthly ad hoc reports to staff, management and external agencies.
11. Communicate and educate in regards to financial improvement analyses, denial issues and recommendations.
12. Maintain current knowledge of third party reimbursement regulations.
13. Operations Analysis: Independently identifies and resolves issues of moderate complexity.
14. Analyzes reporting data to identify issues, trending and resolution possibilities/solutions.
15. Actively participates in payer reimbursement issues until adequate resolution has been reached.
16. Communicates effectively across system and with payer representatives.
17. Demonstrate ability to work with staff to resolve problems and correct deficiencies in processes with staff and contracted payers.
18. Participates in performance improvement through planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, task forces, cross functional groups, projects and discussion with hospital and medical staff as observed by manager.
19. Systems Analysis and Integration: Active participation in system upgrades and enhancements, functional testing, and identifying solutions to complex contract pricing system build challenges.
20. Participates in designing interactive spreadsheets to meet the needs of PFS customers.
21. Independently build, tests and implements contracts at a moderate difficulty level. Ability to update, test and maintain hundreds of contracts across the system.
22. Team Building: Seeks and respects the views of others, internal and external.
23. Creates and updates internal documents and distributes as necessary to support the needs of others.
24. Participates in meeting the objectives of the work unit and goals of the department.
25. Promotes and contributes positively to the teamwork of the department by assisting co-workers, contributing ideas and problem-solving.
PHYSICAL 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 job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Frequent walking, standing, stooping, kneeling, reaching, pushing, lifting, grasping are necessary body movements utilized in performing duties through the work shift. Must be able to sit for extended periods of time. Visual acuity must be within normal range.
2. Must have reading and comprehension ability, read and write legible English, communicate effectively.
3. Must have manual dexterity to operate keyboards, fax machine, telephone and other business machines.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. The work environment is a standard office environment.
SKILLS AND ABILITIES:
1. Good communication skills are necessary to interact effectively with management, staff and external customers.
2. Extensive knowledge of personal computers and Microsoft Excel and Access software preferred.
3. Familiarity with medical terminology and Patient Financial Services experience preferred.
4. Ability to work independently and as a collaborative group
5. Ability to handle and maintain confidential information.
6. Ability to work under high stress conditions.
7. Ability to adapt to various workloads and assignments.
8. Ability to work with multi-disciplinary groups and facilitate meetings.
9. Ability to prioritize tasks.
10. Ability to work in a fast paced and rapidly changing environment. Must be flexible.
11. Must have independent decision-making ability.
12. Familiarity with healthcare contract analysis preferred.
Additional Job Description:
1. Epic Contracts Management and System Application Build
2. Strong understanding of Epic HB workflows, analytics and technology.
3. Experience with business operations workflow in a healthcare environment including payor relations, admissions, billing, and accounts receivable.
4. Experience with building system application packages and moving through multiple environments.
5. Strong understanding of payor reimbursement methodologies (DRG, CPT,OPPS,IPPS, IRF, APC, PDPM)
6. Strong understanding of payor contracts and HB revenue cycle functions for various facility types including Acute, Critical Access, Sole Community, Home Health, Hospice, Skilled Nursing, Behavioral, and Physical Therapy.
7. Computer skills relevant to position including advanced Excel modeling with Visual Basic/.NET programming., Access Database Development, and SQL.
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
655 SYSTEM Contract Management
Top Skills
What We Do
The WVU Health System, which operates under the brand name WVU Medicine, is comprised of 22 member, managed, and affiliated hospitals in West Virginia, Maryland, Ohio, and Pennsylvania. It is West Virginia’s largest healthcare system and largest private employer with more than 2,500 licensed beds, 4,900 providers, approximately 30,000 employees, and more than $5 billion in total operating revenues.
It includes:
• J.W. Ruby Memorial Hospital in Morgantown (flagship), including WVU Medicine Children’s in Morgantown and Fairmont Medical Center in Fairmont;
• United Hospital Center in Bridgeport;
• Camden Clark Medical Center in Parkersburg;
• Berkeley Medical Center in Martinsburg;
• Barnesville Hospital in Barnesville, Ohio;
• Braxton County Memorial Hospital in Gassaway;
• Garrett Regional Medical Center in Oakland, Maryland;
• Harrison Community Hospital in Cadiz, Ohio;
• Jackson General Hospital in Ripley;
• Jefferson Medical Center in Ranson;
• Potomac Valley Hospital in Keyser;
• Princeton Community Hospital in Princeton, including The Behavioral Health Pavilion in Bluefield;
• Reynolds Memorial Hospital in Glen Dale;
• Saint Francis Hospital in Charleston;
• St. Joseph’s Hospital in Buckhannon;
• Summersville Regional Medical Center in Summersville;
• Thomas Memorial Hospital in South Charleston;
• Uniontown Hospital in Uniontown, Pennsylvania;
• Wetzel County Hospital in New Martinsville;
• Wheeling Hospital in Wheeling;
• And five institutes – the WVU Cancer Institute, the WVU Critical Care and Trauma Institute, the WVU Eye Institute, the WVU Heart and Vascular Institute, and the WVU Rockefeller Neuroscience Institute.
The WVU Health System also provides management services to Grant Memorial Hospital in Petersburg.
For more information, visit WVUMedicine.org
