Underpayment Analyst - Reimbursement - Central Div.
Reimbursement - Central Div.
The Underpayment Analyst provides reviews and resolves patient accounts 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.
* Identification of under/overpayments on patient accounts and taking appropriate action to resolve the account.
* Proactively trend and monitor information to ensure appropriate posting of contractual. Report back any negative collection trends to the Director as they occur.
* Participate in weekly meetings to include department and denial meetings.
* Comply with all reimbursement and billing procedures for regulatory, third party, and private insurance payors.
* Working Daily reports as assigned including but not limited to: Claim error report, Audit report, Payment Variance.
* Work closely with ARU Team to resolve account or payer issues, including identifying if underpayment or overpayment issue is related to payor, incorrect insurance, or billing error.
* Work with CBO team in effort to update contract loading issues so that the correct expected reimbursement is reflected upon pricing of the claim.
REQUIRED KNOWLEDGE & SKILLS:
* Strong Collection experience a must.
* Prior Managed Care experience a plus.
* Ability to read and understand complex contract terms and the ability to communicate and/or resolve the deficiencies with both internal and external customers.
* Ability to read and understand and apply managed care contracts as it relates to expected reimbursement on a facility claim.
* Prior Meditech & nThrive experience a plus.
* Strong Mathematical and Analytical Skills.
* Excellent communication skills, both written and verbal.
Education: Bachelor's degree or equivalent experience.
Experience: Minimum of five years' medical billing/Collections/Business Office experience required.
Software/Hardware: MS Office suite. Meditech & nThrive preferred.
Job Status: Full Time
Job Reference #: 54138