Contract Management Reimbursement Analyst

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.

USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Responsibilities

Loads executed managed care contracts into the contract management system; updates contracts with scheduled rate changes as of effective dates; builds new service definitions and implements new reimbursement methodology into the system as required; consults with contract negotiators to recommend precise language and meaning of contracts; ensures that the contract template accurately calculates the terms of the contract as negotiated; monitors periodic changes in recognized coding schemes (ICD, CPT, and DRG) to anticipate impacts on contract language, calculations and reimbursement of specific contracts using those codes; reviews cases and writes appeals; assists in coordinating and maintaining the reimbursement program for USA Health System to ensure compliance with current payments, rules and legislative regulations that impact billing and collections processes; monitors and ensures compliance with Medicare and Medicaid documentation guidelines for USA Health; monitors and evaluates current reimbursements/payment rules and ensures legislative and regulatory changes impacting USA Health; communicates to the clinical faculty, staff and departmental billing personnel any changes impacting billing; assists physicians in determining appropriate use of codes for maximizing reimbursement of services; develops techniques for effective analyses of billing collection efforts; ensures compliance with Medicare and insurance carrier guidelines related to documentation, coding and medical necessity; analyzes and develops systems related to billing, collecting and reporting of professional and medical services to ensure recovery of all professional and technical charges; trains new personnel in appropriate charge capture; provides reimbursement patterns and trend analyses to managers and physicians; provides on-going in-service training for billing personnel as well as clinical faculty including training in coding (CPT, ICD-10-CM, HCPCS); assists in resolving third party denials received by Billing and Collections department and assists with reimbursement appeals and problems; prepares reports and analyses to include financial reports, setting forth progress, adverse trends and appropriate recommendations or conclusion; participates in meetings with subordinates to ensure compliance with established practices to new policies and to keep employees aware of changes and current standards; regular and prompt attendance; ability to work schedule as defined and overtime as required; related duties as required.

Qualifications

Bachelor's degree from an accredited institution as approved and accepted by the University of South Alabama and one year of medical coding or related experience. Directly related experience may substitute on a year-for-year basis for the required education. Certified Professional Coder is required.