- Review trends in third party payments, compare actual payments to managed care contract reimbursement schedules and government payer fee schedules
- Works closely with Managed Care Contracting to ensure accurate set up of contract rates in contract management system
- Effectively shares finding across the broader finance team to increase visibility and improve overall revenue integrity
- Create, prepare and distribute under and over payment reports to be shared with contract payers for timely payment enforcement.
- Communicates with all other revenue cycle departments to efficiently address gaps in workflow or missed opportunities
- Reviews and analyzes reimbursement claims and contracts to ensure compliance with regulatory requirements, payer guidelines and internal policies
- Stays updated with changes in healthcare regulations and reimbursement methodologies ensure compliance and adapt reimbursement process accordingly
- Conducts reimbursement audits and identify opportunities for process improvement and revenue optimization
- Collaborates with Clinical, Revenue Cycle, Corporate Compliance, Health Information Management, Internal Audit and other Revenue and Finance departments on revenue management initiatives.
- Provide guidance, communication and education on correct charge capture, coding and billing processes to clinical / ancillary departments and entities.
- Engages with service department staff and affiliates to develop and maintain audit programs which reconcile services performed to charges captured.
- Assists in the resolution of pre-billing charging issues and post-payment charge related denials.
- Collaborates with other departments and software vendors to facilitate resolution of process issues and implementation of improvement changes.
- Prioritizes and manages multiple tasks and projects simultaneously.
Education / Licensure : Bachelor’s degree
Experience :
- Bachelor’s degree in Business Management, Accounting, or related work experience.
- 5 - 7 years of hospital revenue cycle experience or healthcare data analytics experience.
- Demonstrated proficiency in the use of data analysis tools.
- Computer literacy required including working knowledge of relevant software packages such as Microsoft Office.
Skills :
- An overall understanding of financial management and reporting in health care.
- An overall knowledge of the functions and activities of hospitals and medical clinics.
- Ability to participate with upper management in a decision support mode through the development of appropriate management information.
- Understanding of compliance issues and their importance and consequences.
- Knowledge and skill in using personal computers for electronic mail communications and Internet access along with internal intranet utilization.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all possibilities, duties and skills required of personnel so classified.
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