Transplant Revenue Analyst

Do you have the career opportunities as a(an) Transplant Revenue Analyst you want with your current employer? We have an exciting opportunity for you to join St. David's South Austin Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare.

This position is responsible for the review of pre-evaluation and global service agreements. He/she will be responsible for analyzing provider payments, handling provider inquiries and maintaining good customer relations. The Revenue Analyst is responsible for the oversight analysis of insurance contract payments and disbursements for both insurance and PSA contracts. Additionally, the Transplant Contract and Revenue Analyst will be responsible for overseeing and auditing payors and provider payments and revenue for transplant account reimbursement and Medicare cost report activities.

Accountable for understanding and keeping current with transplant payor contracts and provider agreements. Responsible for Reconciling BMT, CAR-T, and other large dollar Rx accounts against revenue codes to ensure the more significant charges are captured before claims are released for the final bill.

Must be able to understand general ledger for proper expense of accounts payable to help with month-end reporting

• Processes UB04, HCFA and submitted expenses for provider claim adjudication. Knowledge of hospitals and professional billing standards. Ensure incoming claims are documented and filed daily for timely processing. Submits claims to the appropriate insurance company based on the process outlined in each transplant contract.
• Familiar with MCR payment guidelines which include CPT, HCPCs for diagnostic testing, surgery and labs. Responsible for investigating procedure codes for claims payment.
• Must enter and identify all claims in the global billing database as either a physician or a facility claims under the appropriate phase of transplant. Identify if claims are included or excluded in case rate to calculate appropriate reimbursement of claims.
• Research vendor contracts and addresses inquiries regarding possible errors with processed claims.
• Keeps accurate records of claims denials, processed claims, and accruals for accounting. Knowledge of excel and proficient with formulas and data entry.
• Proficient in understanding the phases associated with Global Reimbursement and Global Contracts. Ensures Global provider claims are processed according to contract. Must enter and identify all claims in the global billing database as either a physician or a facility claims under the appropriate phase of transplant. Identify if claims are included or excluded in case rate to calculate appropriate reimbursement of claims
• Works collaboratively with providers, insurance provider relations representative and the revenue cycle center to resolve any billing/claims related issues.
• Ability to conduct research in a variety of systems for appropriate payment of provider claims and research of patient billing issues in both clinical and revenue cycle systems utilized for transplant.
• Understands how to extract data from financial support systems. Maintains financial reports as directed.
• Monitors revenue cycle accounts and payment discrepancies as required
• Cross-trained for assisting in other financial roles within the transplant departmen

Education: Bachelor’s degree or 4 years’ equivalent experience

2.

Experience:

Minimum of 2 years of direct experience in hospital revenue cycle and/or transplant operations.

3. Employee completes initial and ongoing training and competencies as defined by service

line, facility and department/unit which are specific to the needs of the patient population

served (if applicable)