Revenue Cycle Regulatory Research Analyst

It's more than a career, it's a calling

MO-REMOTE

Regular

Job Highlights:

Qualifications: Compliance experience with a focus on Revenue Cycle is strongly preferred.

Schedule: Full Time, Days (business hours)

Location: Remote - reside in MO, IL, OK, or WI

At SSM Health, we believe in providing our employees with a fulfilling career. We strive to create an environment where individuals can grow both personally and professionally. Our company values diversity, innovation, and collaboration, and we are committed to making a positive impact on the communities we serve.

Joining SSM Health means becoming part of a team that is dedicated to providing exceptional patient care and making a difference in people's lives. Our employees are passionate about what they do, and their commitment to our mission is what sets us apart.

Remote work: This position may be eligible for remote work in accordance with SSM policies. Note that remote work is not permissible in some states; Human Resources should be consulted for additional information and guidance. 

*Candidates must reside in MO, IL, OK, or WI

Job Summary:

Supports the system’s revenue cycle by serving as regulatory oversight and regulatory change management duties for current and new lines of business and expansion efforts. Acts as subject matter expert; interprets payer guidelines for clean claim submission; develops and analyzes trend reports; researches, interprets, and provides guidance on federal, state, and local regulatory mandates, payer policies and contracts. Responsible for performing in-depth analysis of proposed and final rules to ensure revenue cycle departments are aware and informed with changes to support operational compliance.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Identifies and evaluates emerging compliance, coding, and financial risks, utilizing regulatory guidance, resources, and data analytics on an ongoing basis to educate and implement leading regulatory compliant practices. 
• Works with revenue cycle and operational departments to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory billing guidelines.  
• Interprets and analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building appropriate procedures and workflows.  
• Communicates summarized potential impacts of regulatory or payer guideline changes to affected leaders with recommended action plans.  
• Develops informative educational materials for any changes and/or updates. 
• Serves as a subject matter expert on existing and proposed regulations related to Medicare, Medicaid and other payer charging/billing processes including those promulgated under health care reform. 
• Reviews Medicare intermediary and third-party payer bulletins, memos, and websites to keep current on coding requirements and pending changes, communicating relevant information to all applicable departments.  
• Performs Ad Hoc research related to billing and coding questions as needed. 
• Performs other duties as assigned. 

EDUCATION

• Bachelor's degree or equivalent years of experience and education

EXPERIENCE

• Three years' experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 
 
State of Work Location: Illinois, Missouri, Oklahoma, Wisconsin

• Certified Coding Associate (CCA) - American Health Information Management Assoc (AHIMA)
• Or
• Certified Coding Specialist (CCS) - American Health Information Management Assoc (AHIMA)
• Or
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Assoc (AHIMA)
• Or
• Certified Healthcare Financial Professional (CHFP) - Healthcare Financial Management Association (HFMA)
• Or
• Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC)
• Or
• Certified Professional Coder (CPC®) - American Academy of Professional Coders (AAPC)
• Or
• Certified Risk Adjustment Coder (CRC) - American Academy of Professional Coders (AAPC)
• Or
• Certified Revenue Cycle Representative (CRCR) – GCC for international audience - Healthcare Financial Management Association (HRMA)
• Or
• Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association (HFMA)
• Or
• Certified Specialist Accounting and Finance (CSAF) - Healthcare Financial Management Association (HRMA)
• Or
• Certified Specialist Business Intelligence (CSBI) - Healthcare Financial Management Association (HRMA)
• Or
• Certified Specialist Payment and Reimbursement (CSPR) - Healthcare Financial Management Association (HRMA)
• Or
• Certified Specialist Physician Practice Management (CSPPM) - Healthcare Financial Management Association (HRMA)
• Or
• Executive of Healthcare Revenue Cycle - Healthcare Financial Management Association (HRMA)
• Or
• Fellow of the Healthcare Financial Management Association (FHFMA) - Healthcare Financial Management Association (HRMA)
• Or
• Registered Health Information Administrator (RHIA) - American Health Information Management Assoc (AHIMA)
• Or
• Registered Health Information Technician (RHIT) - American Health Information Management Assoc (AHIMA)

Work Shift:

Day Shift (United States of America)

Employee

8700080033 Regulatory Research RCO

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 

• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

Explore All Benefits

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.