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Reimbursement Analysis Specialist

2 months ago

Kansas City, Missouri, United States University Health Full time

Job Overview

The Reimbursement Analysis Specialist will be responsible for assessing and interpreting contract language as it pertains to various reimbursement methodologies, including but not limited to Per Diems, DRGs, Fee Schedules, and Percent of Charge mechanisms. This role involves evaluating payer performance through comprehensive analysis, investigation, and resolution facilitation.

Key Responsibilities

  • Communicate contract-related issues, interpretations, and modifications to both internal and external stakeholders as necessary.
  • Review, analyze, and appeal payer underpayments and recoveries related to payer contracts.
  • Conduct follow-up activities with the Managed Care team for necessary rate sheet modifications.
  • Provide exceptional customer service and resolution support by identifying and addressing issues with key contracts.

Qualifications

The ideal candidate will possess extensive knowledge of Medicare, Medicaid, and third-party payment programs, along with a thorough understanding of payer contract terminology. This position is recognized as a subject matter expert, leveraging proficiency and expertise to enhance quality and efficiency in operational processes.

Minimum Requirements

  • Bachelor's degree or equivalent experience through a combination of education and professional background.
  • A minimum of two years' experience in managed care or government payer payment variance reconciliation.
  • Familiarity with 837i and HIPAA transaction sets, including ICD/CPT/HCPC coding, revenue codes, and ICD10, along with a solid grasp of medical terminology.
  • Strong critical thinking and problem-solving abilities.
  • Proficiency in Microsoft Office applications.
  • Expertise in spreadsheet analysis.
  • Strong graphic presentation skills.
  • Attention to detail and excellent communication skills, both oral and written.
  • Outstanding customer service capabilities.

Preferred Qualifications

  • Experience in a healthcare setting, particularly within a hospital environment.