Job Description

MISSOURIEN.

CLASSIFICATION SPECIFICATION

CLASS TITLE: FINANCIAL REGULATORY ANALYST SUPERSEDES: 03/15

CODE: 7598 ISSUED: 3/2015 REVISED: 09/2019

BASIC FUNCTION AND RESPONSIBILITY

Assist Manager of Revenue Management with research, interpretation, implementation and ongoing review of various governmental and commercial payers' rules, regulations and guidelines that impact the Healthcare System's financial operations such as the hospital chargemaster, coding, billing, reimbursement and governmental/third party audits.

CHARACTERISTIC DUTIES

Provide assistance with a variety of tasks related to monitoring contractual, regulatory, billing, coding and reimbursement guidelines to assess the financial impact on the Healthcare System.

Provide assistance with a variety of tasks related to review and analysis of data for identified issues, topics, concerns that may have a financial impact on the Healthcare System.

Provide assistance with a variety of tasks related to external audit processes, data collection and responses to such governmental entities as the Center for Medicare/Medicaid Service, Missouri HealthNet program, Office of the Inspector General and other governmental agencies as may be necessary.

Provide assistance with a variety of tasks to ensure that the hospitals are paid in accordance with the payment schemes of governmental (Medicare, Medicaid, Tri-Care, etc.) and commercial insurance payers.

Provide assistance with a variety of tasks related to research of medical policies, coverage and reimbursement criteria to provide data to and participate in the activities of Health System-Wide Committees, IT Implementation Teams, Revenue Cycle Committee, Value Analysis Team.

SUPERVISION RECEIVED

Direction is received from assigned manager.

SUPERVISION EXERCISED

None.

QUALIFICATIONS

Requires a Bachelor's degree in Accounting, Business, Finance, Analytics, Hospital Administration, or Clinical discipline or a combination of education and experience.

Requires three years or more experience in areas such as health care billing; reimbursement methods; governmental/hospital regulations; information systems and processes and/or health care auditing processes.

Experience with coordinating, reviewing and responding to governmental agency, i.e. OIG, requests, audits and other types of reviews is highly preferred.

Experience with and/or understanding of governmental and/or commercial payment methodologies and medical policy criteria is highly preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of or how to access and research CPT and ICD-9 and/or ICD-10 codes, DRG's, APC's and medical terminology is highly desirable. Knowledge of or how to access and research government rules, guidelines and regulations. Demonstrated ability to identify steps required to manage projects including analysis and application of findings from research, adherence to timeframe, use of resources, consideration of impact on computer systems. Display a high level of problem solving, analytical and decision-making skills which include strong internet research abilities. Ability to work independently as well as function as a team member. Strong interpersonal and communication skills, both written and oral, are necessary. Computer proficiency, especially related to Microsoft Office products, is necessary. Computer experience with GE/IDX and Cerner computer products is desirable.

This document is a general description of typical job duties, responsibilities and qualifications of employees holding the associated job title. Additional duties, specific qualifications and work emphasis may vary between individual positions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

PERFORMANCE EXPECTATIONS

This job description is not designed to cover or contain a comprehensive listing of activates, duties or responsibilities that are required of the employee for this job; however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to quarterly performance reviews. Basic function, responsibilities and characteristics duties may change at any time with or without notice.