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Reimbursement Compliance Analyst

2 months ago

Glen Allen, Virginia, United States Patient First Full time
Key Responsibilities:
  • Collaborate with the Payor Relations team and designated personnel to develop comprehensive and detailed reporting for the auditing process;
  • Review and validate the data generated by the Remit Analysis program for precision and thoroughness, implementing modifications as instructed;
  • Engage in the assessment of resources necessary to execute the auditing function;
  • Conduct quality assurance evaluations (collecting and analyzing data) of all payors' reimbursement on a regular schedule to ensure adherence to contract reimbursement standards utilizing all available programs and tools;
  • Examine data to identify underlying causes of reimbursement issues and offer solutions for resolution;
  • Communicate with relevant parties and departments regarding areas of noncompliance, monitoring and following up with all stakeholders until issues are addressed;
  • Deliver appropriate status updates as required;
  • Participate in various team meetings to discuss findings, comprehend contracts, and provide assistance when needed;
  • Engage with payors and other external entities as necessary;
  • Contribute to additional projects as assigned;
  • Operate, utilize, and maintain office equipment as trained.
Minimum Qualifications:
  • High school diploma or equivalent is mandatory; some post-secondary education in a relevant field is advantageous;
  • A minimum of two years of experience with Patient First is essential;
  • In-depth knowledge of the Patient First billing system is required;
  • Certification as a Certified Professional Coder (CPC) is mandatory; Certified Professional Medical Auditor (CPMA) certification is preferred;
  • Five years of prior experience in payor billing within a high-volume, multi-payor contract environment is desirable;
  • Proficiency in Microsoft Excel, including the ability to create and manipulate pivot tables and complex formulas, is required; familiarity with other Microsoft products or data analysis software is a plus;
  • Exceptional written and verbal communication skills;
  • Ability to prioritize and manage multiple tasks simultaneously;
  • Self-motivated individual capable of working independently and meeting productivity targets.