Under limited supervision develops, analyzes, reports and interprets complex financial information to assist management in evaluating and executing the organization’s business plans in compliance with the Health Services Cost Review Commission (HSCRC) and Center for Medicare and Medicaid Services (CMS) regulations for multiple facilities. Knowledgeable resource to advise and support administrative and/or clinical departments and other hospital staff as needed. Analyzes, interprets and summarizes hospital specific volume data and trends. Assists with financial projects with administrative and/or clinical staff. Responsible for training other Analysts and supporting routine and special projects. The employee will be assigned to a specialized functional area such as case mix, charge description master (CDM), policy and methodology, and/or rate setting.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Analyzes, interprets, summarizes and distributes routine reports for monthly financial processes to ensure accurate revenue recognition and compliance. These reports include, but are not limited to, financial statement revenue analytical packages, case mix analytical packages, audit impact accruals, uncompensated care data, market shift analysis, exclusion reports and CDM / revenue integrity audits.
2. Produces and submits various reports and data submissions to external agencies. Ensures complete and accurate data capture in compliance with published regulations and deadlines for assigned hospitals.
3. Works collaboratively with departments within and outside of Finance to ensure compliance with all regulatory submissions and requirements.
4. Coordinates the development of educational in-services to clinical departments, CBO, IS&T and other administrative staff related to CPT, CMS and HSCRC regulations as well as charging and billing issues.
5. Responsible for performing audits with a focus on accuracy, maintaining compliance with regulatory agencies, and assisting facilities with charge capture, billing, coding, clinical documentation and compliance issues.
6. Analyzes reports to determine areas of improvement or in need of further investigation; determines appropriate plan of action and works with department to rectify any charge capture problems. Exhibits a general knowledge of hospital specific charge capture processes to be able to effectively resolve issues.
7. Provides analytical and technical support regarding hospital volume changes and helps to resolve the issues identified.
8. Monitors and analyzes variances in financial, patient-level coded, and charge data to determine areas of improvement or in need of further investigation. Determines appropriate plan of action and works with departments and others to coordinate resolution of issues and identification of opportunities for improvement.
9. Fulfills ad-hoc data and reporting requests as needed.
10. Assists team members and management in developing, enhancing, and maintaining standard processes, reports, databases, and reference data to support accurate, consistent, efficient, and quality service to internal and external customers.
11. Participates in testing and data validation during new system implementations and upgrades to existing systems.
12. Attends and participates in in-service training and various educational programs for continuous professional development.
13. Trains and educates analysts and other new hires.
14. Prepares and leads meetings, under limited guidance from supervisor, with clinical departments, hospital leadership, and internal stakeholders.
15. Independently creates ad-hoc reports and analysis to solve complicated problems for hospital, clinical, and departmental leadership.
16. Possesses a basic to intermediate knowledge and understanding of the skills necessary for the specific functional area in which they are assigned.
The following statements are intended to describe the specialized skillset required to work in the defined functional area. People assigned to this classification are expected to have a basic to intermediate knowledge / understanding of the skills listed.
Case Mix Oversight
1. Knowledge of case mix abstract data including how it is accumulated and processed, CMI analysis, and HSCRC quality programs such as MHAC, RRIP, & PAU.
2. Ability to aggregate/manipulate large datasets containing financial, demographic, utilization, and clinical data elements from disparate data sources using various Microsoft Access/Excel, SAS and Tableau data manipulation tools.
3. Ability to effectively communicate and present HSCRC case mix, quality and utilization technical information to a diverse groups including finance, clinicians, administration staff, and others within the industry.
Charge Description Master (CDM) Oversight
1. Knowledge of charge master components, coding and Epic charge master description application.
2. Ability to oversee the processes to establish, maintain and continuously update and monitor the accuracy of the charge master files in various hospital and clinical systems, including oversight of annual CPT and quarterly HCPCS updates, compliance to State and Federal billing / compliance regulations.
3. Knowledge and understanding of all charge processes within the organization and providing oversight to staff who assist other department managers/directors with determining chargeable services and appropriate CPT/HCPCS coding. Ensure clinical department staff comply with established charge capture and charge reconciliation policies and procedures.
Policy and Methodology
1. Initiates and develops new reporting and/or analysis of UMMS hospital performance on various HSCRC policies and methodologies to enhance revenue maximization and/or performance improvement opportunities.
2. Identifies opportunities and provides analytic and data support for system-wide Clinical Performance Improvement (CPI) strategic initiative.
3. Assists with the negotiation, financial analysis & reporting for risk contracts associated with UMMS Physician Quality Care Network (QCN). Rate Setting
1. Knowledge and experience in HSCRC reimbursement, Maryland Healthcare Commission (MHCC), and HSCRC/Medicare Cost Reporting.
2. Ability to understand, interpret, measure and formulate financial models along with the development of UMMS’ strategies related to local and national reimbursement policy changes.
3. Ability to effectively communicate and present HSCRC rate methodology, quality and utilization, as well as technical information to a diverse groups including finance, administration staff, executives and other external stakeholders.
What You Need to Be Successful:
Education and Experience
1. Bachelor’s degree is required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred. 2. One (1) year professional financial, reimbursement, or analysis experience is required. 3. Healthcare-related finance background is preferred.
Knowledge, Skills and Abilities
1. Ability to process, assess, and summarize large amounts of financial and clinical data into useful information.
2. Knowledge and experience with spreadsheets, word processing, and other finance related software programs. Knowledge of databases (MS-Access), SAS, and/or Tableau preferred but not required.
3. Understanding of data flow and information systems of business operations.
4. Concern for quality and ability to identify errors and implement corrections.
5. Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.
6. Ability to work effectively in a matrix work environment and to manage multiple deadline-driven tasks and projects.
7. Minimal knowledge or demonstrated ability to learn and understand HSCRC/CMS regulations, CPT (Current Procedural Terminology), and ICD-10 coding.
8. Ability to operate a personal computer is required. Proficiency with the following applications is required: MS Excel, MS Word, and PowerPoint. MS Access, SAS, & Tableau is preferred.
9. Ability to handle confidential issues with integrity and discretion.
10. Ability to prioritize and manage work in a stressful environment.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.