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Contract Compliance Analyst $1000 Sign on Bonus!!

Methodist Health System Omaha, NE
  • Purpose of Job
    • Responsible for review of denials for commercial / government, physician / facility and escalation of appeals to the payers as needed to obtain the maximum reimbursement in compliance to payer contracts and CMS regulations.
  • Job Requirements
    • Education
      • High School Diploma or General Educational Development (G.E.D.) required.
      • College coursework in accounting and or health care preferred.

    • Experience
      • Minimum 1-2 years experience working for a 3rd party payer or health care provider required.
      • Minimum 1 year of insurance billing experience preferred.
      • Six months Institutional and Professional ICD and CPT coding preferred.
      • Six months experience with DRG reimbursement and outpatient including ASC grouper, ER and outpatient reimbursement preferred.
      • Experience in researching Institutional and Professional claims to determine correct contract reimbursement using payer contracts preferred.

    • License/Certifications
      • N/A

    • Skills/Knowledge/Abilities
      • Skill using Microsoft Office, including Word, Excel, and Outlook.
      • Skill performing 10 key data entry.
      • Skill with verbal and written communication.
      • Knowledge of medical terminology.
      • Knowledge of patient accounting software and payer websites.
      • Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
      • Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.
      • Knowledge of facility contracting rates.
      • Knowledge of CMS (Center for Medicare and Medicaid Services).
      • Knowledge of WPS ANSI remark codes.
      • Ability to maintain confidentiality.
      • Ability to read and understand payer explanation of benefits (EOB).
      • Ability to use basic accounting and math principles.
      • Ability to identify, trend and analyze data.
      • Ability to learn new software programs.
      • Ability to organize and prioritize work.
      • Ability to work independently.
      • Ability to identify and trend issues to improve or streamline processes.
      • Ability to maintain a professional demeanor with internal and external contacts.
  • Physical Requirements
    • Weight Demands
      • Light Work - Exerting up to 20 pounds of force.

    • Physical Activity
      • Occasionally Performed (1%-33%):
        • Balancing
        • Climbing
        • Carrying
        • Crawling
        • Crouching
        • Distinguish colors
        • Kneeling
        • Lifting
        • Pulling/Pushing
        • Reaching
        • Standing
        • Stooping/bending
        • Twisting
        • Walking
      • Frequently Performed (34%-66%):
        • Hearing
        • Repetitive Motions
        • Seeing/Visual
        • Speaking/talking
      • Constantly Performed (67%-100%):
        • Fingering/Touching
        • Grasping
        • Keyboarding/typing
        • Sitting

    • Job Hazards
      • 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)
        • Equipment/Machinery/Tools
        • 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
      • Note: Safety Officer can assist with identification of job hazards
  • Essential Job Functions
    • Essential Functions I

      • Analyze denials compared to the applicable contract agreements, payer medical policy language, NMHS coding and authorization processes.
        • Analyze payments to ensure accuracy and initiate corrective action with third party payers.
        • Demonstrates understanding of contract and reimbursement language.
        • Maintain a follow up and reporting system to ensure receipt of reimbursement.

      • Analyze and research contractual and reimbursement issues and answers inquiries from internal and external sources.
        • Correct handling of denial.
        • Resolve denial in RCA according to department policy.
        • Timely follow-up of denials, appeals, etc.

      • Assist staff with work volume as needed.
        • Respond to special requests with accurate information.
        • Provide contract/payor recommendations.

      • Participate in payer meetings and escalates payer issues.
        • Assist with tracking payer agenda issues.

      • Provide training on contracts and reimbursement to other areas as needed.

    • 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.

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Date Posted July 3, 2022
Date Closes September 1, 2022
Requisition 24410
Located In Omaha, NE
SOC Category 00-0000.00

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