PDL Revenue Operations Analyst

Pacific Diagnostic Laboratories seeks a PDL Revenue Operations Analyst for their Administration department responsible for the overall day-to-day operations of denials management, appeals, self-pay inventory, claims write-offs, client edits, client portal usage, payer policy changes, AR aging across all payer classes, insurance eligibility and insurance discovery trends. Actively oversees, maintains, and communicates denials and appeals activity to clients and internal stakeholders. Provides guidance and direction to the team to ensure the department maintains or exceeds goals including total AR collections, credit balances, # of and amount of edits and denials, identifies emerging trends in claims payments and assesses expected vs actual reimbursement. Ensures all activities are performed in compliance with Cottage Health (CH) and PDL policies, procedures, and Federal and State regulations. Assists in recruitment, retention, training and work allocation.

QUALIFICATIONS:

All job qualifications listed indicate the minimum level necessary to perform this job proficiently.

Education:

• Required: Bachelor's degree or equivalent Lab RCM work experience of 6 years.

Technical Requirements:

• Required: Must be able to demonstrate an understanding of ICD-10 coding for Lab CPT's, working payer denials and appeal processes. Expertise in healthcare insurance eligibility, verification and claims filing procedures. Expertise in utilizing software applications to maximize automation and efficiency in a business office setting. Proficient in Microsoft Office suite, with an emphasis on Excel and PowerPoint. Able to analyze data to identify trends and opportunities for process improvement.
• Preferred: MS-Office 365.

Years of Related Work Experience:

• Required: Five years LAB RCM experience, preferably in a multi-facility environment including three (3) years of progressive responsibility in healthcare revenue cycle. Experience working with legal consent policy and procedures and payer contracting and policies. Knowledge of medical terminology.
• Preferred: Minimum if five (5) years related work experience.