Reimbursement Analyst, Managed Care

Overview

• Reimbursement Analyst, Managed Care, Days, 80 Hrs / 2 wks
• Location: Janesville, WI, OR Rockford, IL OR hybrid remote
• Schedule: Monday - Friday; flexible work schedule available after training period

Under the direction of the Managed Care Director the Revenue Cycle Reimbursement Analyst will be responsible for reviewing payor contracts and payor variances for hospital and physician services. This role is responsible for analyzing the hospital and physician current accounts receivable for Managed Care, finding underpayments and denials and working with the insurance carriers to maximize reimbursement under our contracts.

Responsibilities

• Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
• Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends.
• Research and trends denials from payors.
• Reads through healthcare contracts and contract language and ensures proper contract workflows.
• Researches remittances and Explanation of Benefits EOBs for complete accurate payments or denials.
• Work with payers to understand specific reasons for variances and or denials and measures to prevent future denials.
• Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned.
• Develop sound and well-supported appeal arguments, where an appeal is warranted.
• Submits corrected claims and appeals.
• Coordinates appeals with clinical or coding areas within the revenue cycle.
• Requests appropriate adjustments, when required.
• Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules.
• Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times.

Education and Experience

Associates degree in finance, business, or healthcare administration and 3 years experience working in revenue cycle, denials management and contract management required. 5 years of experience in lieu of degree.

Special Physicial Demands

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.While performing the duties of this job, the employee is frequently required to sit; use hands to handle, finger, feel; reach, talk and hear. The employee is occasionally required to stand and walk. This is light work exerting up to 25 pounds of force occasionally. Specific vision abilities required by this job include constant close vision. Frequent ability to adjust focus. Prolonged sitting. Manual dexterity needed to operate telephone and keyboard.

Culture of Excellence Behavior Expectations