PFS Analyst

At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

Position Summary: Responsible for informing and supporting the strategic and operational leadership of the Patient Financial Services (PFS) Department. Contributes to the financial strength, compliance, and overall performance of PFS and Revenue Cycle operations by providing information, analytics, reports, and best practice knowledge for the Revenue Cycle functions, including hospital and physician (provider) services. Provides assistance to the Lead Director Revenue Cycle by providing support and knowledge to the Director of Patient Access, the Director of Health Information Management to ensure collaboration and alignment of the Revenue Cycle areas and workgroups with a major emphasis on denials and denials prevention. Key role to assist in monitoring and facilitating improvement in the overall quality, timeliness, completeness, and accuracy of Revenue Cycle processes (such as cross disciplinary root cause analysis of issues). Data integrity, tracking issues, reporting of performance and impacts of improvement initiatives and standard KPIs is required. Ensure the effectiveness of Revenue Cycle policy, practices and technology platforms.
Responsibilities include:
• Denials Management / Write-Off Reduction
• Claim Edits / Clean Claim Rate
• Technology Requirements
• Process Design
• Alignment with all Revenue Cycle Initiatives
• Staffing Models
• Alternate Financing
• Price Estimation
• Workflow Design
• Vendor Management
• KPI Dashboards and Reports
• Updating Work plans and Monitoring Tasks and Goals
• Strategic Design of Revenue Cycle Operations
Essential Duties:
• Support the Lead Director to develop, provide strategic direction and oversee the operation and process design of systems and procedures to ensure efficient functioning of the Revenue Cycle Operations with a major emphasis on denials and denials prevention.
• Ensure development of industry best practice operating procedures with consistent application in all business units by providing industry knowledge and subject matter expertise.
• Ensure all compliance and regulatory standards are maintained.
• Is a participant to develop, monitor and manage operations utilizing industry metrics on a monthly, annual and long-range planning basis. Support development of metric report cards to quantify improvements in productivity, quality, service and overall financial results.
• Is the gate keeper for the Revenue Cycle Workgroups and Strategic Teams Work plans and ensures timely updates are completed and presented to various Committees with a major emphasis on denials and denials reduction.
• Provide expertise to denial mitigation and revenue preservation activities in collaboration with organization and revenue cycle leaders, both hospital and provider.
• Assist in setting and achieving annual and periodic goals and key performance indicators in support of Revenue Cycle operations and overall financial performance including monitoring and updating those in the Workgroups and Strategic Teams.
• Ensure effective communication and coordination with other functional areas to achieve desired service levels.
• Participate in drafting and reviewing processes for Revenue Cycle policies and procedures.
• Partner with patient service leaders to ensure that processes are working effectively, efficiently and accurately.
• Assist in evaluating appropriate and key outsourcing partnerships such as revenue analytics and transfer reviews.
• Ensure strong technology functionality to support all elements of Revenue Cycle as it relates to revenue cycle and interfaces with clinical and other operational areas. Examples are Patient Service Contact Center, POS Collections, Referrals and Authorizations.
• Communicate with other revenue cycle leaders to establish accountability and coordination between Revenue Cycle and other departments.
• Assist with special analysis and projects as needed.
• Provide support at all supported entities within CMH.
Technology:
• Seek and recommend new information technology solutions and or manual changes that support Patient Financial Services Departmental functions.
• Work collaboratively with departmental personnel to implement systems and process changes aimed at improving Revenue Cycle performance.
• Ensure compliance with outside regulatory requirements are documented (i.e. Pricing Transparency, CMS regulations, Managed Care contract terms).
Management Reporting and Monitoring:
• Review and analyze on-going Revenue Cycle KPI’s based on computer generated data and manual reports.
• Utilize departmental work plans to monitor initiative and project goals, progress, and outcomes.
Training and Education:
• Assist in ongoing programs for staff development and training that foster and mentor the next generation of Revenue Cycle leaders.
Professional Development:
• Attend local and regional conferences/seminars to remain current in supporting the needs of the organization.
• Review industry publications to maintain knowledge base and stay current on best practice solutions.
• Maintain current knowledge of regulatory developments involving agencies (CMS, AHA, DHS, and Joint Commission.)
• Maintain certifications as applicable.
• Maintain membership with professional associations (HFMA, etc.).
Education and Experience:
• Bachelor’s degree required, or eight (8) years related experience in lieu of, and
• Eight (8) years or more of experience in Finance or Revenue Cycle.
Knowledge, Skills and Abilities:
• Detailed knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
• Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10).
• Expertise in reviewing claims denials, determining root cause, and implementing processes to resolve future denials.
• Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
• Working knowledge of Medical Record, Financial Services and Healthcare Application technology.
• Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.
• Able to effect collaborative alliances and promote teamwork.
• Effective organizational, planning, controlling, scheduling and project management abilities.
• Effective managerial and administrative abilities as applied to the management of multiple projects.
• Effective leadership abilities.
• Financial acumen with ability to extract data, ensure integrity, produce reports and utilize for communicating results and affecting change.
• Excellent communications skills, both oral and written.
• Demonstrated ability to work well with diverse people, excellent human relation skills.
• Flexible and able to react to ever changing priorities.
• Ability to engage patients and team members utilizing the CMH Experience Standards:
• Serve as the champion of the patient and team member experience by providing an A+ experience to every patient and team member, every day

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!