Hospital Reimbursement Analyst, Excela Health

UnitedHealth Group - Greensburg, PA3.6

Full-timeEstimated: $51,000 - $64,000 a year
The Reimbursement Analyst is responsible for maximizing Excela Health's reimbursement. The Reimbursement Analyst will maximize reimbursement by analyzing payer contracts, understanding and analyzing government regulations and reviewing and analyzing payments for correct billing and correct payments from payers. The Reimbursement Analyst will understand and be able to interpret reimbursement methodologies, billing and medical language so that effective and efficient analysis is provided. The Reimbursement Analyst is responsible for data gathering, periodic reporting, analysis, understanding operations of Excela Health, proficiently uses contract management, analyze contracts, and understands reimbursement. Continuously looks for ways to improve the financial performance of the organization by looking for efficiencies. Communicates status of tasks/issues and results in an efficient and effective manner.

Primary Responsibilities:
Analyzes third party payer contracts and payments
Reads, analyzes, reports on third party payer contracts in an efficient manner and sufficiently in order to communicate to Senior Management the benefits or lack thereof of the contract in order to provide the best reimbursement for the hospital-division
Review, analyze, report on third party payer payments to ensure that Excela Health is being paid sufficiently for services rendered using tools such as PIC and an accounts receivable report that shows low payments or no payments as a percent of charges, and an aged trial balance
Report on third party payer payments in order to be able to achieve trends and to measure effectiveness of the payer payments analysis process
Effectively track payer contracts using TractManager and by keeping paper contracts in an orderly fashion so that contracts can be easily retrieved
Updates third party payer rates and calculations and applies those rates and calculations to applicable software, spreadsheets, and reports
Work with other departments to maximize Excela Health's reimbursement
Work with the Clinical Resource Management department to decrease denials and maximize reimbursement
Work with the Patient Accounting department to improve the billing process and to maximize reimbursement
Work with the Quality department to maximize reimbursement through quality initiatives including, but not limited to, Value Based Purchasing (Core Measures, Patient Experience, Outcomes, Efficiency), Readmission Reduction, Highmark Quality Blue (or any other payers quality reimbursement programs), etc.
Work with other departments as needed to maximize reimbursement and to be a good service provider
Maintaining knowledge of various regulations
Read and attend seminars to maintain knowledge of various regulations and best practices and then apply that knowledge
Maintains, updates current software and hardware and communicates needs for updates and initiates process
Maintain revenue charges
Provide analysis of periodic price increases, including what charges need to increase, decrease, and stay the same
Pricing of charges, including the price of supply charges
Work with the Charge Description Master Coordinator to ensure proper pricing
This position requires pre-employment screening for Tuberculosis as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity.

Required Qualifications:
Undergraduate degree or equivalent experience
1+ years of experience in healthcare revenue cycle and/or facility network contracting

Knowledge of DRG, APC hospital reimbursement methodologies

Proficiency with MS Office (Outlook, Excel, Word)

Preferred Qualifications:
Healthcare finance related work experience (claims research, contract management, reimbursement, patient billing and/or claims analysis)
Analytical skillsets to evaluate contracts and payments

Ability to create and conduct effective presentations

Ability to multi-task and prioritize assignments

Sound judgment, problem solving skills, strong oral and written communication skills, ability to follow directions from other team members; works independently assigned duties

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.