Payment Integrity Analyst-Reimb. (R00040771)

Managed Care Payment Integrity Analyst - Contract Reimbursement - Payor Contracting

The Payment Integrity Analyst is accountable for monitoring and recovering variances between expected and actual reimbursement from payers. This role will perform payment integrity functions such as, interpret contract language, ensure accurate contract estimated reimbursement, reconcile claim billing per contract guidelines, monitor and review payor performance / reimbursement, and engage with other departments and vendors to resolve reimbursement discrepancies.

Education & Experience Required : Bachelor degree in applicable job-related field and three (3) years of experience in related healthcare setting.

Certifications, Licenses, or Registration Required : N / A

Preferred Qualifications : Master's preferred. Transplant billing requirements for solid organ and bone marrow with appeals and reconsideration process preferred.

Knowledge, Skills, and Abilities : Advanced knowledge of provider reimbursement methodologies. Proficiency in Microsoft office, healthcare reimbursement and CMS payment methodology. Knowledge of medical terminology ability to maintain confidentiality. Intellectual capacity to read and interpret facility and professional contracts, analyze payment trends and aggregate information into a digestible format. Demonstrated analytical skills to discover root cause of errors and correct. Good verbal and written communication skills. Maintains professional standards. Effective organizational skills. Basic computer skills, including but not limited to proficiency in Microsoft word, Excel, and basic data entry. Advanced knowledge of third-party insurance plans and government insurance claims.

Responsibilities : Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations. Focuses daily on complying with policies, processes and department guidelines for assigned managed care duties. Validate billing and payment for service is accurate. Research and understand discrepancies in reimbursement and take appropriate measures to resolve. Has a basic understanding of provider claim reimbursement; is knowledgeable and proficient with payer websites and other useful resources pertaining to revenue cycle functions. Collaborates with management and co-workers in an open and positive manner. Contributes to a positive working environment.

Environmental and Physical Demands : Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, no activities subject to significant volume changes of a seasonal / clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting / carrying up to 10 pounds, occasional lifting / carrying up to 25 pounds, occasional lifting / carrying up to 50 pounds, occasional lifting / carrying up to 75 pounds, occasional lifting / carrying up to100 pounds, no lifting / carrying 100 pounds or more, no climbing, no crawling, occasional crouching / stooping, occasional driving, occasional kneeling, occasional pushing / pulling, frequent reaching, frequent sitting, frequent standing, occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more).

Time Type : Full time

FLSA Designation / Job Exempt : Yes

Pay Class : Salary

FTE % : 100

Work Shift : Day