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Reimbursement Analyst

Methodist Health System Omaha, NE
  • Purpose of Job
    • Analyze Hospital and Physician revenue reimbursements identify and recover overpayments/underpayments.
  • Job Requirements
    • Education
      • High school diploma or equivalent required.
      • Bachelor's degree in business, finance or health care related field preferred.

    • Experience
      • 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.

    • License/Certifications
      • N/A

    • Skills/Knowledge/Abilities
      • 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.

    • 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
  • 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.

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