Supports financial sustainability of organization through timely, accurate and ongoing analysis of payor reimbursement, identifies and resolves reimbursement issues, identifies trends in payments and denials, ensuring that claims processing is accurate and compliant with reimbursement terms and policies outlined in payor agreements, serves as expert in payor reimbursement policies. Completes ad hoc analysis to support business needs, evaluates existing and proposed contract rates. Produces and maintains price transparency files in accordance with regulatory requirements. Coordinates and delivers reimbursement and payor policy training.
Primary Duties and Responsibilities:
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Analyzes and identifies reimbursement trends and issues through routine reimbursement quality audits, proposes and creates meaningful, efficient solutions.
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Analyses claim denial appeal processes, developing efficiencies, providing education and monitoring for sustained improvement.
- Serves as payer policy and reimbursement expert.
- Evaluates new and emerging payment models, policies, and requirements.
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Participate in Revenue Cycle audits, offering guidance, education and support to participants on reimbursement, denial and payor policy related matters.
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Maintain expert knowledge of Price Transparency requirements, responsible for maintenance and compliance of published files.
- Responsible for maintenance and submission of Rural Health Clinic wrap around reports.
Skills and Abilities:
- Skilled in exercising strong analytical and problem-solving skills.
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Advanced understanding of revenue cycle processes and the ability to work collaboratively with various departments to achieve reimbursement excellence.
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Advanced ability to evaluate and translate payor reimbursement contract language and policies into business requirements.
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High degree of accuracy and ability to collaborate with others
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Self-directed and thorough
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Advanced skills in Microsoft Office products (Excel, Word, PowerPoint)
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Work collaboratively within a team setting
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Must demonstrate strong personal integrity
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Able to apply corporate policies and procedures to address daily problems and situations
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Organizational and planning skills including the ability to adapt to frequent interruptions, prioritize tasks, maintain performance under pressure, and anticipate the needs of others
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Resource management skills, including the ability to effectively manage time
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Excellent interpersonal abilities, as well as written and verbal communication skills
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Must possess skills in identifying problems, planning and implementing their solutions.
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Maintain composure in stressful situations
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Bachelor’s Degree in relevant field required.
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American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification required.
- Five (5) years’ progressive healthcare revenue cycle experience required.
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Professional or academic experience with statistics, analytics and/or data analysis required.
