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Revenue Integrity Administrative Analyst
3 months ago
Description As a Revenue Integrity Administrative Analyst, you will play a crucial role in managing and auditing claims to ensure accuracy and compliance. Key responsibilities include: Track and follow up on Stop-loss related claims for various carriers, including sending re-bills and addressing denied claims. Audit claims leakage for all Managed Care payors, validate capitation deductions, ensure contractual rates are applied, and provide executive summaries for Stop-loss, TPL, and other recovery items. Initiate, track, and follow up on TPL claims, interface with vendors, law firms, providers, and patients, and collaborate with programmers to enhance claims recovery processes. Implement processes to identify under-allowed claims, review EOBs for accurate payment postings, verify contracts, analyze variances, and validate underpayments in accordance with payer policies. Establish effective contacts with payer offices, inform management of payer performance issues, compile appeals for reimbursement, prepare monthly performance statistics, and participate in meetings to discuss managed care contract trends. Maintain confidentiality of medical records and stay current with managed care reimbursement trends. Salary Range: $30.56-$60.82/hourly Qualifications We're seeking a detail-oriented, analytical, and collaborative professional with: Two to five years of experience in Revenue Cycle functions and Billing & Collections. Understanding of government and commercial payer insurance, and laws governing Revenue Cycle processes. Knowledge of Medical Terminology. Proficiency in Microsoft Office, specifically Excel. Ability to establish and maintain cooperative working relationships with physicians, staff, patients, and administrative personnel. Independently analyze information or problems, identify trends, and implement solutions. Ability to perform advanced healthcare finance calculations accurately. Ability to maintain helpful, caring, and courteous relationships with patients, co-workers, and physicians. Working knowledge of the organization and how to resolve issues. #J-18808-Ljbffr
