JOB SUMMARY
Under the general supervision of the Manager of Revenue Integrity, this role is responsible for maintaining an in-depth understanding of payer contracts and reimbursement methodologies. The Revenue Integrity Analyst applies these methodologies in various contexts, including but not limited to: identifying and resolving payment variances related to denials or inaccurate contract adjudication, forecasting expected reimbursement for new service lines, auditing existing services and procedures for accurate payment, and providing adjudication information to the Patient Financial Services (PFS) department as needed. The Analyst is committed to excellence by delivering high-quality products and services that enhance the patient and family experience. Additionally, the role involves recognizing and demonstrating a thorough understanding of patient and family-centered care.
PRIMARY JOB RESPONSIBILITIES
Use contract management system to identify and quantify variances between actual and expected insurance payments for facility and professional services. Appeal accounts as needed for under payments and follow-up on the appeals. Work with the denial recovery team on appeals of underpayments. Perform contract review/analysis to identify root cause of payment variances. Have a strong knowledge of Managed Care contract terms. Responsible for documenting and communicating findings within and across key departments (Revenue Integrity, PFS, Finance, IT)Attend payer meetings as needed.Assist in the on-going validation and integrity of the Contract Management system’s data and contract set up. Communicate payer/billing concerns to the billing manager and billing staff. Verify that new charge codes are processing and reimbursing as expected by collaborating with the Revenue Cycle Analyst to review new codes in the Chargemaster and comparing them to claim charges. Analyze new service lines, including reimbursement from Medicare, Medicaid, and Blue Cross payers, and collaborate with the finance team to develop cost summaries related to these new services. Work with Community Mental Health payers to update contracts and negotiate new rates annually. Review, track, and process single case agreements with non-contracted payers as needed. Run various month end reports as requested to support revenue cycle and financial close. Investigate refund requests from payers for potential claim overpayments by comparing the requested refunds against the contract fee schedule to validate their accuracy. Works collaboratively with revenue cycle leaders to implement best practices and improve overall revenue cycle performance. Communicate payer and billing concerns to Patient Financial Services (PFS) leadership and stay informed about changes in billing and reimbursement policies for various payers. Must be able to work effectively with others and complete tasks within specified deadlines. Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior. DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES
Performs other duties as assigned.JOB SPECIFICATIONS
EDUCATION
Associates Degree or in lieu of degree, 5+ years of relevant experience required. Bachelor's Degree highly preferredCertified Revenue Cycle Representative (HFMA) and/or certification of medical billing/office administration preferred. EXPERIENCE
Two to five years’ experience with professional and/or facility insurance billing required. Ability to prioritize workload; demonstrated organizational and problem solving skills. Ability to work independently. Knowledge of various health insurance payment structures- DRG, APC, per diem, etc. preferred. Working knowledge of Hospital billing systems and Practice management systems preferred. Demonstrate proficiency with Microsoft Word, and advanced level experience Microsoft Excel is required. ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS
Able to travel independently throughout all Memorial Healthcare facilities. Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC)ESSENTIAL TECHNICAL ABILITIES
Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare. ESSENTIAL MENTAL ABILITIES
Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations. Ability to read and interpret a variety of documents including but not limited to policies, operating instructions, white papers, contracts, regulations, rules and laws. Have good research and analytical skills.ESSENTIAL SENSORY REQUIREMENTS
Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates and manuals. Able to hear for work-related purposes. INTERPERSONAL SKILLS
Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication. Required to remain calm when adversity is encountered. Open, honest, and tactful communication skills. Ability to work as a team member in all activities. Positive, cooperative and motivated attitude. PI249340890
Source : Memorial Health Care Center
