Revenue Integrity Analyst- contracts

3 weeks ago

Nashville, United States ResCare Full time

Our Company

BrightSpring Health Services

Overview

As a Revenue Integrity Analyst - Contracts within the RWW Revenue Cycle department, you will play the process owner for payer plan maintenance in managing Payer contracts for various lines of business with RWW. This includes communication with operations and appropriate IT teams to ensure business partners are appropriate educated; This includes rate changes notifications from ops. This role will be responsible for creating and owning the Payer Master File (PMF) for RWW. Must be proficient in reading payer contracts and interpreting their meaning, payment rates, and for effectively communicating the same. This position will work with the Revenue Cycle Team to ensure correct billing and payments. This position involves with updating payer plans within the core systems and must have the ability to analyze the information and share findings. Must have the ability to work with multiple teams to ensure collaboration and effective communication. Ensure compliance with corporate policies

Responsibilities

  • Maintain an up-to-date repository of payer contracts, amendments, and renewals for RWW.
  • Audit contract, prior to movement into production in contract management system
  • Document payers by facility by payer
  • Translate payer contracts into "shared" site for tracking and reference.
  • Must completed accurate payer setup, contractual allowance setup and calculation of expected reimbursement in multiple billing systems.
  • Perform validation of contract terms by reviewing account examples and confirming correct expected reimbursement generated and report any differences.
  • Monitor and track contract performance and compliance.
  • Collaborate with the contracting team to ensure correct interpretation of contract, timely loading of contracts, and reimbursement rates.
  • Conduct in-depth analysis of Payer contracts, identifying opportunities for system improvements.
  • Collaborate with the Revenue Cycle team to implement revenue-maximizing strategies, and
  • Collaborate with contracting to provide support for fee schedule negotiations and value-based care initiatives.
  • Proficiently navigate and utilize RWW revenue cycle software and systems.
  • Troubleshoot system-related issues and liaise with IT support when necessary.
  • Stay current on healthcare regulations and reimbursement policies.
  • Generate comprehensive reports and conduct in-depth data analysis to track contract performance and financial outcomes.
  • Timely reporting of payment variance(s) and review(s)
  • Ability to understand payment methodology and utilize formulas with system syntax to correctly program reimbursement rates for contracted commercial and governmental payers.
  • Present findings and recommendations to the management team for informed decision-making and strategy development.

Qualifications

  • Bachelor's degree in Accounting, Business, or a related field is preferred.
  • 3+ years of experience in contract management and working with reimbursement methodology. or payer relations.
  • Strong knowledge of Payer contracts, healthcare reimbursement methodologies, and regulations.
  • Proficiency in using healthcare revenue cycle software and data analytics tools.
  • Exceptional communication, negotiation, and relationship-building skills.
  • Analytical and problem-solving capabilities.
  • Ability to work independently and collaboratively in a team.
  • Detail-oriented with strong organizational skills.
  • Knowledge of healthcare compliance and regulations.
  • Prior experience in contract negotiation and management is a plus.

About our Line of Business

BrightSpring Health Services is a leading provider of complementary home and community-based pharmacy and health services for complex populations in need of chronic and/or specialized care. Through the company's pharmacy and provider services to seniors and specialty (including behavioral) populations, we provide comprehensive care and clinical services in 50 states to over 360,000 customers, clients and patients daily. The company's services foster greater patient and family satisfaction, improve outcomes and reduce health care system costs, and are supported by industry-leading quality outcomes. For more information, visit www.brightspringhealth.com. Follow us on Facebook, Twitter and LinkedIn.

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