Associate Decision Support Ana at Appalachian Regional Healthcare, Inc.
United States
<h2>Overview</h2> <p>We are seeking a detail-oriented Decision Support Associate to support enterprise data integrity,</p> <p>state reporting, reimbursement analytics, Axiom contract maintenance, reconciliation processes,</p> <p>capital workflow support, and labor meeting preparation. This role is ideal for someone who</p> <p>enjoys working with healthcare data, investigating variances, maintaining accurate mapping and</p> <p>contract information, coordinating process workflows, and supporting timely, reliable reporting</p> <p>for operational and financial decision-making.</p> <h2>Responsibilities</h2> <p>• Prepare, validate, submit, and monitor Kentucky IPOP state reporting files in accordance with required timelines, file specifications, validation requirements, and follow-up correction processes.• Prepare, validate, submit, and monitor West Virginia HIDI state reporting files, including monthly file submission, error review, correction coordination, and confirmation of successful completion.• Review overnight processing jobs and report issues, failures, delays, or data concerns to appropriate stakeholders for timely resolution.• Monitor daily transaction posting audits to confirm completeness, accuracy, and appropriate processing of daily activity.• Review daily claims calculated with an expected payment of zero and investigate causes, including mapping, contract, rate, fee schedule, coding, or system configuration issues.• Maintain Enterprise Decision Support dimension tables and related mapping tables to support accurate reporting, analytics, cost accounting, productivity reporting, reimbursement analysis, and downstream system processes.• Complete annual updates and ongoing new-code maintenance for key coding and mapping structures, including CostItem/CDM, revenue codes, CPT codes, and related reference data.• Maintain provider mapping to ensure claims, encounters, service activity, professional fee reporting, and provider-based analytics are linked accurately and consistently across systems.• Maintain employee ID mapping used to link payroll files to decision support, productivity, staffing, labor, and cost accounting reporting processes.• Maintain contract company information used to link locum providers and contract labor arrangements to professional fee reporting and related financial analytics.• Perform routine maintenance of Axiom contracts, including quarterly Medicare and Medicaid lab fee schedule updates, quarterly Medicare and Medicaid APC schedule updates, maintenance of CMS factors for PPS contracts, monitoring CMS factor changes, miscellaneous updates to commercial payor fee schedules, rates, and thresholds, annual CMS factor updates, and annual contract maintenance involving creation or modification of provisions as needed.• Maintain log of all changes made to Axiom contracts, including the reason for change, effective date, source documentation, and validation status when applicable.• Process Summit requests for Axiom access in accordance with internal access procedures, approval requirements, and security expectations.• Perform reconciliation of Cost Detail and Encounter Payment data, including payments, refunds, and adjustments, to support data integrity, completeness, and accurate downstream reporting.• Investigate variances, mapping issues, missing data, rejected records, and reconciliation exceptions; document root causes, corrective actions, status, and resolution timelines.• Coordinate with Revenue Cycle, Payroll, Contract Management, Finance, IT, and operational stakeholders to resolve data issues, validate source-system changes, and ensure reporting processes remain accurate and timely.• Support development and maintenance of standard operating procedures, mapping documentation, reconciliation logs, contract change logs, access documentation, and audit-support materials for recurring decision support processes.• Support Capital Planning workflows by reviewing submitted capital projects for appropriate routing and confirming the correct project group assignment, including Facilities, ITCE, or Other, before projects are moved to tracking.• Support Capital Tracking workflows by completing the Capital Admin step for fully approved projects daily to move projects forward to Buyer Review, Materials, or the next appropriate workflow step while preventing tracking queues from becoming backlogged.• Coordinate Capital Meeting preparation by working with analysts, RBDs, and other stakeholders to collect, compile, and validate PowerPoint materials for quarterly and board capital meetings, ensuring slides are accurate, complete, and updated as project details or proformas change.• Support Labor Management Committee meeting preparation by creating weekly meeting agendas using available BEX file information and distributing the agenda within required Thursday morning timeframes.• Assist leadership with ad hoc data validation, analysis, reporting, and process improvement initiatives related to enterprise decision support, state reporting, cost accounting, contract maintenance, reimbursement analytics, and system access support.Key Accountabilities• Regulatory reporting accuracy: State submissions are completed timely, validated thoroughly, and corrected promptly when errors are identified.• Daily monitoring and issue resolution: Overnight processing jobs, transaction posting audits, and expected-payment exceptions are reviewed consistently, with issues escalated and resolved timely.• Data governance and mapping integrity: Dimension tables, coding structures, provider mappings, employee identifiers, and contract company mappings are maintained consistently and with appropriate documentation.• Axiom contract maintenance: Fee schedules, CMS factors, PPS contract provisions, commercial payor rates, thresholds, and annual contract updates are maintained accurately and supported by change logs.• Reconciliation integrity: Cost Detail and Encounter Payment activity reconciles to expected source totals, with variances documented, investigated, and resolved.• Process documentation: Recurring processes are supported by clear procedures, change logs, validation steps, access documentation, and audit-ready support materials.• Capital and labor workflow support: Capital project routing, tracking workflow steps, capital meeting materials, and Labor Management Committee meeting agendas are supported accurately and timely.• Cross-functional collaboration: Issues are coordinated effectively with Finance, Revenue Cycle, Payroll, Contract Management, IT, and operational partners.</p> <h2>Qualifications</h2> <p>Education• Bachelor’s degree in finance, accounting, healthcare administration, business analytics, information systems, or a related field; equivalent relevant experience may be considered.• Experience working with healthcare financial, clinical, claims, patient accounting, reimbursement, or decision support data, preferred.• Strong proficiency with Microsoft Excel, including data review, reconciliation, filtering, lookups, and variance analysis.• Ability to interpret data file requirements, validation reports, mapping tables, and system output to identify and resolve discrepancies.• Strong attention to detail, organizational skills, and ability to manage recurring deadlines with minimal supervision.</p> <p> </p> <p>Minimum Work ExperienceTraining is available, but the experience below is a plus:• Experience with Axiom, Meditech, state hospital reporting portals, contract management systems, payroll data, or healthcare decision support platforms.• Knowledge of healthcare coding structures, including CPT, revenue codes, charge description master concepts, provider identifiers, and encounter-level data.• Experience with Kentucky IPOP, West Virginia HIDI, cost accounting, productivity reporting, reimbursement analytics, professional fee reporting, or claim expected-payment review.• Experience maintaining healthcare payer contracts, fee schedules, reimbursement rates, CMS factors, PPS provisions, APC schedules, Medicaid schedules, Medicare schedules, or related contract configuration.• Experience documenting standard operating procedures, reconciliation processes, mapping logic, contract change logs, access request support, and audit-support materials.</p> <p> </p> <p>Required Skills, Knowledge, and Abilities• Ability to work with large data sets and identify trends, anomalies, missing values, mapping issues, and reconciliation variances.• Understanding of healthcare data flows, including encounters, charges, payments, refunds, adjustments, payroll identifiers, provider mapping, and professional fee reporting.• Ability to translate technical data issues into clear explanations, corrective actions, and business impacts for non-technical stakeholders.• Strong written and verbal communication skills, including the ability to coordinate issue resolution across departments.• Ability to prioritize recurring reporting deadlines, maintenance requests, reconciliation activities, and ad hoc analysis needs.• Commitment to data integrity, confidentiality, compliance, and continuous process improvement.</p>
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