REVENUE CYCLE ANALYST - 40001015

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GENERAL DESCRIPTION:

The primary purpose of the Revenue Cycle Analyst position is to improve the revenue cycle at the Department of Public Health by analyzing and optimizing the processes that generate funds for the department. This position works with colleagues to ensure accurate, timely, and compliant medical billing and collection is completed in accordance with billing policies and regulatory requirements.

DUTIES AND RESPONSIBILITIES:

The essential functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.

• Monitor, analyze, and report on all components of revenue cycle from patient registration to final payment.
• Monitor revenue cycle performance metrics such as denial rates, collection rates, and financial trends.
• Evaluate billing and reimbursement processes to identify areas for improvement.
• Ensure billing codes (CPT, ICD-10, HCPCS) are correctly captured and reflected.
• Review claim denials, analyze root causes of high denial areas, and coordinate corrective actions to reduce rejections.
• Implement preventive measures by adjusting workflows to reduce denials.
• Contact patients and payors as needed to solve problems.
• Monitor, evaluate, and complete various work queues in the electronic records system
• Assist with revenue backlogs to ensure timely posting.
• Analyze large data sets using Excel (pivot tables) and other tools.
• Prepare financial reports and dashboards with monthly/quarterly summaries to support leadership decision-making.
• Collaborate with clinical program managers, registration team, billing team, finance team, and IT to improve revenue workflows.
• Conduct team meetings to assess revenue trends and discuss projects for improvement.
• Develop training materials and teach staff revenue cycle procedures, improve workflows, and ensure best practices.
• Work with IT and UNC EPIC to optimize electronic health record system (EHR) to support revenue generating projects.
• Contribute significantly in the implementation of workflow changes by project managing and training staff as needed.
• Suggest and assist with special projects related to the revenue cycle.
• Conduct audits related to registration, billing, and financial performance including analyzing metrics such as denial rates, clean claims, and overall patient data to prevent compliance or reimbursement issues.
• Ensure compliance with Medicaid, Medicare, and other payer regulations.
• Assist with budgeting, forecasting, and audit preparation related to revenue.
• Stay current with regulatory changes and ensure processes align.
• Suggest and support internal and external audit requirements through controls testing, data reconciliation, and documentation.
• Performs related work as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• • Knowledge of various financial and operational metrics to inform decision-making and strategy development in healthcare settings.
  • Knowledge of HIPAA, NCDHHS Coding and Billing Guidance, NCPH Administrative and Clinical Coverage Policies, NC Administrative Codes, NC Immunization Program Coverage, and Family Planning Title X Guidance.
  • Knowledge of medical billing and coding (CPT, ICD-10, etc.) processes.
  • Knowledge of electronic health record (EHR) systems, preferably EPIC.
  • Knowledge of payer regulation.
  • Proficiency in Excel and data visualization tools.
  • Skilled in maintaining effective working relationships with patients, payors, and other employees.
  • Skilled in collaborating with teams of colleagues to solve problems.
  • Strong analytical, project management, and problem-solving skills.
  • Proficiency in Excel and data visualization tools.
  • Ability to provide excellent communication, both verbal and written.
  • Ability to be a systems thinker focused on identifying areas for process improvement to enhance efficiency in healthcare operations.
  • Ability to independently plan and organize individual work and various group projects simultaneously.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS:

• • Bachelor’s degree in health administration, public health, finance or a related field from an appropriately accredited college or university and two (2) years of experience in healthcare revenue cycle or billing operations or;
  • Six (6) years of experience in healthcare revenue cycle or billing operations.
  • Experience with EPIC is preferred.

PREFERRED QUALIFICATIONS:

No license is required, but coursework or certifications related to:

• Medical billing and coding (e.g., Certified Professional Coder, Certified Professional Biller, Certified Coding Associate, or Certified Revenue Cycle Representative)
• Revenue cycle management
• Health information systems (especially EPIC)
• Data analytics or healthcare compliance

PHYSICAL DEMANDS:

Physical demands refer to the requirements for physical exertion and coordination of limb and body movement.

• • Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

UNAVOIDABLE HAZARDS (WORK ENVIRONMENT):

Unavoidable hazards refer to the job conditions that may lead to injury or health hazards even though precautions have been taken.

• • None

STANDARD CLAUSES:

May be required to work nights, weekends, holidays and emergencies (man-made or natural) to meet the business needs of Durham County.

This job description is not designed to cover or contain a comprehensive listing of essential functions and responsibilities that are required of an employee for this job. Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

ESSENTIAL SAFETY FUNCTIONS:

It is the responsibility of each employee to comply with established policies, procedures and safe work practices. Each employee must follow safety training and instructions provided by their supervisor. Each employee must also properly wear and maintain all personal protective equipment required for their job. Finally, each employee must immediately report any unsafe work practices or unsafe conditions as well as any on-the-job injury or illnesses.

Every manager/supervisor is responsible for enforcing all safety rules and regulations. In addition, they are responsible for ensuring that a safe work environment is maintained, safe work practices are followed and employees are properly trained.

To further the mission of the Durham County Department of Public Health (DCoDPH) to partner with our community to advance health equity, protect the environment, and promote health and wellness for all, DCoDPH is implementing the employee vaccination and tuberculosis screening policies. All DCoDPH employees are considered healthcare personnel (HCP) working in a health care setting with the potential for exposure to patients and/or infectious materials and, therefore, are required to comply and provide documented proof of the following:

• • Measles, Mumps & Rubella (MMR) vaccination/immunity 
  • Varicella-Zoster Virus (Chicken Pox) vaccination/immunity 
  • Tdap (Tetanus, Diphtheria, Pertussis)
  • Tuberculosis (TB) baseline screening within the last twelve (12) months prior to employment
  • Hepatitis B vaccination/immunity – only required for DCoDPH employees with potential Bloodborne Pathogen (BBP) exposures.

Identified DCoDPH HCP with potential Bloodborne Pathogen (BBP) exposure have an additional requirement for the Hepatitis B vaccination. Required vaccination, serological testing to determine immunity, and baseline tuberculosis screening are available for all Public Health employees who elect to become DCoDPH patients upon request and at no cost.

Proof of vaccination and tuberculosis screening must be provided to Human Resources within seven (7) business days prior to the date of employment.

AMERICANS WITH DISABILITIES ACT COMPLIANCE:

Durham County is an Equal Opportunity Employer. ADA requires Durham County to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management. 

BACKGROUND CHECK STATEMENT:

This position may be subject to a background check, which could include, but is not limited to, criminal history (employment-related and/or SBI fingerprint-based), credit history, motor vehicle records, educational verification, and checks of the sexual offender registry, depending on the specific requirements of the role. A conviction record does not automatically disqualify an applicant from employment consideration, unless otherwise required by applicable state law.