PFS Claims Management Analyst - 40 hrs/wk.
Company: Blanchard Valley Health System
Posted on: May 28, 2023
PURPOSE OF THIS POSITION
The purpose of the PFS Claims Management Analyst is to provide
support to Patient Financial Services and other departments with
complex functions related to billing and denials. The Claims
Management Analyst will serve as a primary liaison between the
staff and organizational management, develop and generate necessary
reporting of metric performance and enhance the current claims edit
process within our claim software system that have resulted in
prevention of a clean claim submission or re-submission on behalf
of Blanchard Valley Health System The Claims Management Analyst
will trend and perform analysis on these edit failures and develop
resolution across the organization.
- Duty 1.Develops and presents various billing and denial key
performance metrics and productivity dashboards to identify
resolution opportunity and workflow improvement in high dollar risk
- Duty 2.Effectively audits reports claim rejections to perform
root cause analysis of billing and departmental staff claims
processing delays, billing/payer related concerns and develop
detailed action plans in efforts of maximizing the organizational
clean claim rate and overall reimbursement.
- Duty 3.Creates and develops process improvement by creating,
maintaining, and effectively presenting self-identified statistics
to organizational stakeholders with aging, high dollar, and
high-volume edits in efforts to resolve and create acceleration of
future claims for optimized payment efforts.
- Duty 4.Serves as the lead point of resolution support for the
billing and denial staff including, but not limited to, payer
policies, payer/organizational contracts, billing edits and process
- Duty 5.Coordinates and discusses complex data analysis between
Patient Financial Services, Revenue Integrity, Managed Care and
various departmental leadership teams. Ensures accurate system
access and completion or assistance of required education and
training for stakeholders.
- Duty 6.Develops and facilitates regular scheduled task force
meetings and ensures reports are distributed in advance to
departmental stakeholders timely. Prepares for meetings by
performing a deep dive analysis at both an aggregate as well as a
detailed level to identify trending, potential risks, and negative
- Duty 7.Actively participates in continuing education
opportunities to remain familiar with organizational and healthcare
industry changes to ensure compliant measures. Utilizes project
management resources and tools to remain current in and promote
industry best practices.
- Duty 8.Provides advanced support, including but not limited to;
billing & denial related patterns and trends, identifying, and
implementing payer issue resolution including Quadax payer
matching, researches and identifies industry standard metrics and
develops ongoing tracking and monitoring of such metrics, and
provides necessary training and education around these
- Duty 9.Assures confidentiality of patient information.
Maintains compliant documentation and records in accordance with
Federal and State regulations in patient account files. Accurately
documents all account activity. Adheres to all HIPAA related
privacy, security and transaction & code set regulations in
compliance with the Federal guidelines.
- Duty 10.Upholds Blanchard Valley Health System's mission,
vision, values, and ethical standards and demonstrate the
behavioral and service expectations as defined in our policies and
- An Associate degree in a related field including, but not
limited to, health information, business, healthcare finance
required or 5years' experience from which comparable knowledge and
abilities have been acquired.
- Applicant must have 3years of comprehensive billing and denial
experience working with commercial and government payer types for
both professional and facility claims.
- Advanced experience with Microsoft office products and ability
to accurately manipulate and analyze data independently.
- Strong understanding of policies, procedures, contractual
language and compliance regulations for hospital and professional
- Strong interpersonal skills, critical thinking skills,
independency, and ability to communicate and educate effectively in
formal presentation format to all levels of the organization.
- Driven to learn and able to gain knowledge of various
departmental processes to determine root cause analysis that result
in overall improvements across the organization.
- Individual must be able to demonstrate the knowledge and skills
necessary to provide care appropriate to the age of the patient
served on his/her assigned unit/department. The individual must
demonstrate knowledge of the principles of growth and development
over the life span and possess the ability to assess data
reflective of the patient status.Must be able to interpret the
appropriate information needed to identify each patient's
requirements relative to their age-specific needs and to provide
the care needed as described in the area's policies and
- CPC certification
- Comprehensive understanding of medical terminology, including
CPT-4, ICD-10, diagnosis and procedures coding, and HCPCS
This position requires a full range of body motion with
intermittent bending, squatting, kneeling, and twisting. The
associate must be able to sit for three hours, walk for one hour
and stand for two hours per day. The associate must be able to lift
20 pounds. The individual must have excellent eye/hand coordination
to operate the machines. This position requires corrected vision
and hearing in the normal range.
Keywords: Blanchard Valley Health System, Toledo , PFS Claims Management Analyst - 40 hrs/wk., Human Resources , Findlay, Ohio
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