- Purpose of Job
- Analyze Hospital and Physician revenue reimbursements identify and recover overpayments/underpayments.
- Job Requirements
- High school diploma or equivalent required.
- Bachelor's degree in business, finance or health care related field preferred.
- Minimum 5 years related work experience required.
- Experience with government and managed care contracts, government regulations, reconciling patient accounts and balancing payment transactions against contract rates and terms preferred.
- Skill with financial accounting and analysis.
- Skill with verbal and written communication.
- Skill using Excel and databases including extracting and merging data from multiple sources.
- Skill critically evaluating situations.
- Skill managing time and projects.
- Skill organizing and prioritizing work.
- Knowledge of hospital and physician billing, revenue cycle and reimbursement.
- Knowledge of healthcare information systems and databases.
- Knowledge of International Classification of Disease (ICD-9/10), Current Procedural Terminology (CPT) Coding, revenue codes, Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
- Knowledge of Medical terminology.
- Ability to work independently.
- Ability to review and understand government and managed care contract language and payment methodologies.
- Ability to effectively work in a team environment.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Physical Requirements
- Weight Demands
- Light Work - Exerting up to 20 pounds of force.
- Occasionally Performed (1%-33%):
- Distinguish colors
- Frequently Performed (34%-66%):
- Repetitive Motions
- Constantly Performed (67%-100%):
- Not Related:
- Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
- Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
- Explosives (pressurized gas)
- Electrical Shock/Static
- Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
- Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
- Rare (1-33%):
- Chemical agents (Toxic, Corrosive, Flammable, Latex)
- Mechanical moving parts/vibrations
- Essential Job Functions
- Essential Functions I
Perform comprehensive account analysis to ensure reimbursement is accurate.
Perform analysis of underpaid claims in order to determine appropriate course of action to ensure accurate, timely and optimal reimbursement.
Research and identify underpayment root causes and trends and assist in the development of corrective action plans for underpayments.
Accurately maintain underpayment databases to identify all underpaid accounts, track reasons for underpayments and to identify trends and problem payers.
Identify contract management errors to minimize internal inaccuracies resulting in false underpayments.
Communicate problematic variances, delays and any other issues impacting reimbursement to management, contracting, payers, and other internal and external stakeholders.
Monitor and track reimbursement related projects and appeals to ensure timely resolution of underpayments.
Maintain accurate and appropriate account documentation in all relevant systems.
Act as a resource to provide reimbursement information.
Participate in testing of patient accounting system and contract management system code upgrades and new system implementations.
Maintain a current knowledge of payer reimbursement policies and contracts.
Essential Functions II
Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.
Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.
Other duties as assigned.