AR Reimbursement/Contract Modeling Analyst

1 month ago

Frankfort, United States University of Louisville Hospital Full time

Overview WE ARE HIRING

Location: Hybrid - 250 E. Liberty St. Louisville, KY 40202

About UofL Health

UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.uoflhealth.org.

Job Summary:

The Reimbursement Analysts work as a team to coordinate and leverage vendor applications providing account level expected reimbursement in support of optimizing hospital revenue. This requires analysis and interpretation of contract information to ensure pricing models or manually priced estimates are consistent with reimbursement logic outlined in payor contracts. Uses reporting tools for data analysis and trending discovery to support underpayment identification. Develop and maintain a collaborative working relationship with contract/payor relations personnel, finance/cost accounting staff, information system staff, revenue integrity/charge master staff, denials staff, auditor staff, management, and preferred vendors. Provide feedback to departments, finance, and UofL Health leaders regarding reimbursement issues.

Responsibilities

Analyst will possess a thorough knowledge of reimbursement workflows along with the interfacing with software/databases/applications currently being used to meet the needs of the department.

Serve as Facility expert on account level pricing based on contract reimbursement methods/rates.

Support training/education of other team members on reimbursement methods and pricing calculations.

Analyze contracts and coordinate with hospital charge master and other departments on reimbursement amounts and use of service/revenue codes.

Coordinate with Financial Counselors and other team members to analyze accounts and develop estimated pricing for procedures.

Maintain compliance with all company policies, procedures, and standards of conduct.

Perform other duties as assigned.

Essential Functions:

Leverage use of current pricing tools as well as help create/adapt new tools for expected reimbursements from payers. Provide recurring payment variance reports for challenging underpayments.

Provide estimates, as requested, for patients & registration staff based on contract rates to maintain pricing transparency for the hospital system.

Validate new contracts/amendments using payment models to ensure integrity of rates. Escalate payment rate discrepancies to Revenue Cycle leadership, as necessary.

Prepare recurring and ah-hoc reports for insurance reimbursement auditors and other teams/departments for prioritization of account reviews.

Analyze late charges and determine appropriateness for rebilling or write off based on expected reimbursement.

Assist in maximizing the performance of information systems to monitor denials, costs/profitability of services by procedure, diagnosis, patient groups and other levels as may be defined to assist all levels of management.

Qualifications Education:

Associate’s degree in business, healthcare, accounting, computer science, or equivalent experience. (required)

Bachelor’s degree in business, healthcare, accounting, computer science, or equivalent experience. (preferred)

Experience:

Understanding of hospital billing and reimbursement for government, managed care, and commercial payers.

Three years of related work experience within the healthcare industry with an emphasis on contract modeling, auditing, or reimbursement. Strong analysis experience in other fields may be considered.

Experience with McKesson STAR, EPSi, StrataJazz, Vitalware, Power BI Reporting or other payer modeling systems desired.

Knowledge, Skills, and Abilities critical to this role:

Knowledge of reading and interpreting payor contracts.

Knowledge of CPT/HCPCs, APCs, MS-DRGs, revenue codes, modifiers, and billing regulations.

Analytical and problem-solving skills with strong attention to detail.

Strong organization and follow up skills with proactive prioritization.

Language Ability:

Strong verbal and written communication skills with the ability to communicate effectively with all levels of staff.

Reasoning Ability:

Ability to read and interpret documents, i.e. contracts, claims, instructions, policies and procedures in written form.

Able to critically think through complex patient situations, process improvements, evidence-based practice.

Ability to work well with ambiguity and continuous changes.

Able to assist others in developing problem solving/reasoning skills.

Computer Skills:

Computer skills including but not limited to Microsoft Office Products (Outlook, Excel, Word, Power Point, etc.).

Intermediate or advanced skills with spreadsheet applications. (Preferred)

Additional Responsibilities:

Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.

Maintains confidentiality and protects sensitive data at all times.

Adheres to organizational and department specific safety standards and guidelines.

Works collaboratively and supports efforts of team members.

Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.

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