Job Description:

This position is responsible for working with the CBO Rev Cycle Applications Supervisor to provide direct support to the Central Business Office (CBO) and other Nemours affiliates by ensuring all professional and hospital electronic and paper claims are transmitted correctly and timely to the responsible parties for prompt adjudication and payment. As part of the Revenue Cycle Applications Team, any and all possible edits, errors, and/or rejections from the processing of these claims or issues surfaced by the CBO, are distributed to and corrected by the CBO Revenue Cycle Analyst. This includes, but is not limited to, maintaining, updating, and correcting the PB/HB Claims and Remittance setup within the Epic Hyperspace and Resolute Text applications, testing and validating all system build and new release functionality, maintaining the electronic and paper claim submission forms, and related items that pertain to claims generation and production. This position is also responsible for ensuring other Resolute Master Files are set up to correctly support claims, remittance, claims status, and other stages of the Revenue Cycle. Works with CBO representatives, and leadership, and other internal departments to perform reviews and analyses of workflows, data collection, report details and other technical issues associated with Epic Resolute Claims and Remittance applications.

The CBO Revenue Cycle Applications Analyst should have the ability to recognize opportunities for process improvement and optimization activities designed to create more knowledgeable end users. The role of this position includes acting as a change agent, educator, and resource in advancing the strategic mission of Nemours.

Essential Functions:

Assist Central Business Office associates, end users, and leadership with claim related issues via Help tickets and/or claims projects with the goal of increasing prompt payment and decreasing front-end (Clearinghouse) and/or back-end (Payor) rejections.

Create and maintain custom programming and rules for electronic and paper claims submissions following all insurance payor, State, ANSI, and other standard billing guidelines and parameters.

Create, maintain, monitor, and when appropriate, resolve claims issues in assigned Epic Claim and Account & Follow-up workqueues.

Create and maintain Remittance Options (RMOs) for use in electronic remittance posting.

Work with clearinghouse and other partners to ensure accurate claims transmission from the clinics and hospitals through appropriate portals and into the payer's system.

Work with Nemours Health Informatics and IS Departments for claims setup, claim status troubleshooting, and remittance workflows.

Work with assigned Epic Technical Support on Epic support log tickets, custom changes/fixes, Release Notes, and Epic upgrades.

Participate in the evaluation, testing and validation of new release and upgrade functionality.

9. Attends scheduled huddles and meetings to discuss team and project related activities, issues, changes, communications, and updates.

Education/Certificatons/Experience:

1. Some College

2. Professional and/or Hospital Billing Claims Administration EPIC Certification (or completion within 6 months of hire date) required.

3. More than 1 year and up to 3 years

Specifics:

Minimum of one (1) years' experience in a healthcare related field, business office, or managed care setting. Understanding of the claims revenue cycle, including but not limited to, standard billing procedures (NUCC, NUBC and ANSI), payments/denials by commercial and Medicaid health insurers, Able to apply critical thinking skills to building and testing of Epic applications. Have the ability to work independently and meet project guidelines/timelines.

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