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Job: Underpayment Reimbursement Analyst

This posting has expired and is no longer available.

Job Description

POSITION SUMMARY: 
The Underpayment Reimbursement Analyst provides guidance on reimbursement to Business Office Employees.  Reviews and resolves reports within the department guidelines. Participates in Performance Improvement activities within the department.  The position requires expertise in systems payer contract interpretation and reimbursement. Identifies payer problems that relate to billing or collections. 
PRIMARY RESPONSIBILITIES: 
  • Identification of under/overpayments on patient accounts and taking appropriate action to resolve the account. The position will require the ability to read and understand complex contract terms and the ability to communicate and/or resolve the deficiencies with both internal and external customers.
  • Proactively trend and monitor information to ensure appropriate posting of contractual. Report back any negative collection trends to the Collection Manager as they occur.
  • Participate in monthly meetings to include department and denial meetings Comply with all reimbursement and billing procedures for regulatory, third party and private insurance payers.
  • Working Daily reports as assigned including but not limited to: Claim error report, Audit report, Payment Variance.
  • Work closely with Collection Team to resolve account or payer issues. Identifying if underpayment or overpayment issue is related to payor, incorrect insurance iplan loaded or Billing error.
  • Work with local Managed Care team in effort to update contract loading issues so that the correct expected reimbursement is reflected upon pricing of the claim.


Qualifications

SKILL OR EXPERIENCE REQUIREMENTS:
  • Minimum of three years medical billing/Collections/Business Office experience Required.
  • Strong Collection experience a must.
  • Prior Managed Care experience a plus.
  • Ability to read and understand and apply managed care contracts as it relates to expected reimbursement on a facility claim.
  • Proficiency in Computer programs such as Microsoft Excel, Word
  • Prior Mckesson STAR experience a plus
  • Strong Mathematical and Analytical Skills
 
EDUCATION OR SPECIFIC TRAINING REQUIREMENTS:
  • Bachelor degree preferred.  Can be waived in lieu of experience

 

Equal Opportunity Employer Minorities/Women/Veterans/Disabled