Job description
Overview
Mednax, Inc. and its affiliated practices operating as Pediatrix® Medical Group (Pediatrix) are one of the nation’s leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix-affiliated clinicians have been committed to providing coordinated, compassionate and clinically excellent services across the continuum of care, both in hospital settings and office-based practices. Specialties including obstetrics, maternal-fetal medicine, and neonatology are complemented by 18 pediatric subspecialties and a newly expanded area of primary and urgent care clinics. The group’s high-quality, evidence-based care is bolstered by investments in research, education, quality-improvement and safety initiatives.
Today through almost 8,000 employees in 38 states, dedicated teams including physicians, advanced practitioners, clinical leaders, business and operational experts work together every day to fulfill our mission to take great care of the patient®. We invite you to join the Pediatrix family and help shape the future of health care.
Business Data Analyst is responsible for the oversight and management of all RCM Billing Systems processes including but not limited to, timely resolution of Ambulatory production processes, claim formats and filing, letters, BBP Package/Job monitoring and daily completion as well as Data Integrity for Ambulatory Business application system. This is done by direct contact with applicable RCM personnel, RCM System Analysts, IS/IT, Data Operations, Provider Enrollment departments as well as our contracted vendors. The Business Data Analyst must be proficient in problem solving techniques, EDI 837/ERA835 logic and effectively utilize appropriate resources, make workable recommendations for changes to resolve business issues. In addition, this role is responsible for the oversight of all activities related to the scheduling and implementation for new Ambulatory practices for Office Based billing and all Billing systems related workflows for all practices. This position is responsible for providing support to all RCM vendors and RCM Corporate departments for all Billing/Collection related issues, concerns and request including but not limited to, tasks, statements, letters, claims, rejections, denials, and ERA remits etc. Software Application skills utilized are: NextGen, Waystar, Change Healthcare, Service Now, Elevate, Master Database, Word, Excel, SharePoint, OneNote/OneDrive and MS Teams.
Responsibilities
Review Ambulatory Billing Solutions requests from Service Now Catalog and determine appropriate action.
Review problems as presented by RCM Corporate Departments/R1 vendor or RCM Business Systems Analysts and determine the appropriate actions to take and present effective solutions to resolve business issues.- Work with RCM users, Data Operations, Coding or IS to help troubleshoot Clinical Billing system issues, resolve problems, including opening support tickets with vendor to resolve software issues or reported problems.
- Provide feedback to requester to communicate progress, schedules, and anticipated testing involvement.
- Conduct additional testing to validate and further define problems presented.
- Prepare or revise service request if change is necessary related but not limited to claims, letters, statements, reports and Background Business Process jobs.
- Prepare and execute test script to test functionality.
- Coordinate all activities with IS, RCM and RCM Business Systems Analysts to have changes tested and moved into production.
- Conduct follow-up with Business or RCM Business Systems Analyst to confirm successful implementation.
- Provide feedback to RCM personnel to educate them on issues related to identifying causes of claim problems and identifying potential solutions.
Perform activities related to daily claims and letters production and validation.
Responsible for communication of daily production issues and follow up to resolution.- Confirm all daily BBP jobs ran successfully.
- Confirm that all vendors have received claims and letters.
- Confirm that all vendor reports received, and volumes transmitted match.
- Contact clearinghouse or Payer, if necessary to validate receipt confirmation of claim, letter and statement files and communicate applicable process failure information or reason for rejection/denial to Practice or RCM staff.
- Identify problems/trends resulting from claims.
- Work with RCM Liaison and Business Analyst to develop corrective action plan.
Perform activities related to daily Vendor processes.
- Conduct daily Vendor extract and Front-End reconciliation process
- Maintain daily extract schedule
- ork with IS or Vendor on any errors and/or issues with vendor extract utility or automation program
Perform End of Month functions as required.
Attend all meetings related to the End of Month process and schedule.- Complete the Clinical Billing System End of Month closing process according to schedule.
Update specific Master File Maintenance/Practice Preferences in Clinical Billing System.
Review, process or work with Data Operations for updates to Billing System File Maintenance/Practice Preferences for procedural changes received from Practice or RCM Corporate Management.- Review and process all Service requests for Adjustment Codes, Payment Codes, and Transaction Message Codes, Task Workgroup, Task Types within 2 business day of receipt.
- Review and process all requests for updates to, Reason Code libraries, ERA Processes and parameters within 2 business day of receipt.
- Process Billing System payer hold/release service request.
Manage the Ambulatory Billing System implementation build in accordance with the established Organic Growth Initiatives (OGI) and Acquisition deadlines. Liaison for Clinical Billing Systems.
- Set up, test and monitor completion of all production EDI processes for claims, letters, statements, reporting and BBP jobs. Report issues internally to Help Desk or Information Systems as needed as well as report issues to external vendors in accordance with process affected.
- Monitor implementation of all EDI and Business Systems workflow/processes before and after Go Live.
- Coordinate, schedule and conduct all build and test activities with applicable contracted vendors.
- Consult and conduct analysis and testing to validate and further define problems presented during and after implementation of each practice onto the Clinical Billing EPM system.
Performs a variety of other Business Data Analysis duties.
Assists on various special projects as determined by the Manager.- Always meets deadline dates and times on assigned projects.
- Work extended hours in mandatory situations.
Performs other job-related duties within the job scope as requested by Management of RCM.
Maintain strict confidentiality in accordance with HIPAA regulations and Company policy.
Any patient private health information (PHI) must not be divulged on any account except to payers that need the information in order to process the claim for payment.
Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
Embodies the principles of the corporate Mission Statement and Philosophy at all times.
Represents the corporation in a positive fashion and makes all individuals feel as comfortable as possible.- Conducts all business in a professional manner maintaining respect for individuals at all times.
Complies with departmental and company-wide policies and procedures.
Maintains constant awareness of potential safety hazards ensuring necessary safety precautions.- Reads and complies with established policies and procedures.
Qualifications
Associate's degree (A. A.) or equivalent from two-year college or technical school; or three or more years related experience and/or training; or equivalent combination of education and experience.
Ability to read, analyzes, and interprets general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from customers and the general public.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to calculate figures and amounts such as discounts and percentages.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to define problems, collect data, establish facts, and draw valid conclusions
Pediatrix is an Equal Opportunity Employer
Pediatrix is an Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status
Safety First
Effective November 1
st
, 2021 Pediatrix will require all employees and new hires to be vaccinated against COVID-19, unless they qualify for an approved medical and/or religious exemption.
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