EDI/RCM Business Analyst
Hanger, Inc. - Austin, TX

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Overview:

Hanger, Inc. (HGR), a leader in the healthcare field of Orthotics and Prosthetics has an opening for a Business Analyst to support their Enterprise Practice Management (PM) system and the enterprise rollout of a Revenue Cycle Management (RCM) solution. This is a professional position with primary responsibilities for the planning, coordination, implementation, and ongoing support associated with the RCM solution.

Responsibilities:
  • Responsible for investigating and introducing industry best practices into Hanger RCM process.
  • Develop a deployment strategy for the RCM Rollout
  • Work with Operations, EDI vendor and trading partners as required to increase the existing number/percentage of electronic claims and payments
  • Work with Operations and Practice Management system vendor to maintain an electronic benefits verification system
  • Coordinate with EDI vendor on the testing and implementation of EDI transactions with new and existing trading partners
  • Work with Operations to identify and implement process improvement initiatives that will streamline billing and collections
  • Work with trading partners as required to understand, document, and disseminate their EDI requirements.
  • Develop production related EDI reporting requirements
  • Interface with Operations and EDI vendor regarding EDI support-related issues
  • Interface with senior/middle management and internal business units to ensure that the RCM program achieves the organization’s strategic goals and business needs
  • Provide guidance on health care trends and effective billing processes to support the department’s EDI personnel
  • Define and implement new or improved work processes to increase quality and efficiency
  • Provide timely reporting to management regarding production issues and trends
  • Resolve non-standard issues that cannot be resolved by the EDI vendors
Additional Responsibilities:
  • Performs other duties or special projects as assigned
  • Ability to complete multiple simultaneous projects in a timely manner

Qualifications:
  • 5+ years healthcare EDI lifecycle (e.g. claims, payments, benefits, patient payments ) experience in a large healthcare production environment
  • Demonstrated experience working with Clearinghouses and Payer claims Portals
  • Familiarity with EDI (X12)
  • 2+ years experience developing Healthcare EDI translation maps
  • Familiar with ICD-10 and HIPPA 5010 standards
  • Demonstrated experience onboarding new payers for electronic claims & electronic payment processing
  • Demonstrated ability to independently research, analyze, and troubleshoot complex EDI-related issues based on a thorough understanding of payer claim cycles and rejection terminology
  • Knowledge of federal and state DME regulations and familiarity with commercial payer rules and regulations
  • Demonstrated experience leading several full life cycle implementations with an understanding of all aspects of an implementation project including, but not limited to, planning, analysis and design, configuration, development, conversions, system testing, cutover and production support
  • Must organize/prioritize work, manage multiple tasks and projects and function effectively as a small-team member.
  • Must be able to function independently, or as a team member, and have superior communication and interpersonal skills.
Preferred Skills/Experience:
  • Experience with NextGen PM/EHR
  • Familiarity with ITIL is desired
  • Healthcare systems (Revenue Cycle Management, Practice Management, Outcomes Assessment, Patient Collections)
  • Work Experience within a Medical Practice, Central Billing Office, Hospital System, or Payer
  • Strong PC skills with a working knowledge Microsoft Office suite, with strong skills in Excel, Word, PowerPoint, Visio and Project.
Required Education:
  • B.S. or B.A. in business or information systems; professional certification in healthcare EDI preferred. Relevant experience with non-analytical degree or equivalent professional training may be substituted.

Hanger, Inc. - 21 months ago - save job - block