Analyst, Revenue Operations - PDS Health

Now is the time to join PDS Health. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!

The primary function of the Analyst, Revenue Operations is to effectively assist in production and collections.  This individual coaches and trains Operation Managers (OM) on the AR Metrics and identifies opportunities to maximize collectible revenue. The Analyst, Revenue Operations ensures that claims are properly billed to the patients and insurance companies and ultimately paid. This position is proactive in its efforts to ensure insurance companies are billed correctly and promptly, as well as receivables are collected effectively in each office.

Responsibilities

• Maximize office collections, communicate issues and implement guidelines/parameters to improve processes.
• Analyze various internal and external reports to review/trace outstanding and complex claim payments, request additional information from practices, make claim corrections, re-submit, and appeal with carriers for proper payment.
• Identify strategic financial solutions for RM and OM to drive higher percentage of payments, faster billing cycles and top line revenue.
• Analyze the AR Metrics to identify offices that need training or billing process improvements.
• Identify opportunities work with regions on best practices and more efficient billing processes.
• Perform daily activities of auditing and billing of assigned practice’s patient claims to ensure accurate and maximum reimbursement for patient treatment from insurance carriers.
• Analyze Explanation of Benefits (EOB) statements and adjust accounts according to PDS claims processing criteria.
• Identify necessary adjustments to accounts and use negotiation skills to obtain claims approval and payment information from various carriers.
• Review and examine AR Report to ensure accounts are properly billed to the insurance.
• Weekly, check the portals (e.g. Request for Information (RI), and Claims Portal) to ensure that any missing information is obtained, so that the claims are billed properly and claims are properly adjudicated.
• Partner with RM and OM of assigned practices to provide feedback around maximizing the collectable revenue for the region/office.
• Communicate trends and suggestions to improve processes to ROC, OM, and RM.
• Other duties as assigned by management.
• Conduct monthly conference calls with RMs and OMs. As well as occasional visits to the region to meet with regional leaders.
• Other duties as assigned by management.

Required

• Bachelor’s Degree in Finance, Business Administration or related field or 2+ years of leading/training individuals on a billing process or 2+ years claims auditing experience is required.
• Experience working with QSI (Quality Systems Inc.).
• Strong computer and data entry skills with competent knowledge of Microsoft Word, Outlook and Excel software applications.

Preferred

• Previous Operation Management experience in with a retail store or medical/dental practice.
• Insurance Claims Auditing experience.

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.