Contract Management Reimbursement Specialist

1 month ago


Mobile, Alabama, United States USA Health Full time
Job Summary

USA Health is seeking a highly skilled Contract Management Reimbursement Analyst to join our team. As a key member of our reimbursement program, you will be responsible for ensuring compliance with current payments, rules, and legislative regulations that impact billing and collections processes.

Responsibilities
  • Loads executed managed care contracts into the contract management system and updates contracts with scheduled rate changes as of effective dates.
  • Builds new service definitions and implements new reimbursement methodology into the system as required.
  • Consults with contract negotiators to recommend precise language and meaning of contracts.
  • Ensures that the contract template accurately calculates the terms of the contract as negotiated.
  • Monitors periodic changes in recognized coding schemes (ICD, CPT, and DRG) to anticipate impacts on contract language, calculations, and reimbursement of specific contracts using those codes.
  • Reviews cases and writes appeals.
  • Assists in coordinating and maintaining the reimbursement program for USA Health System to ensure compliance with current payments, rules, and legislative regulations that impact billing and collections processes.
  • Monitors and ensures compliance with Medicare and Medicaid documentation guidelines for USA Health.
  • Monitors and evaluates current reimbursements/payment rules and ensures legislative and regulatory changes impacting USA Health.
  • Communicates to the clinical faculty, staff, and departmental billing personnel any changes impacting billing.
  • Assists physicians in determining appropriate use of codes for maximizing reimbursement of services.
  • Develops techniques for effective analyses of billing collection efforts.
  • Ensures compliance with Medicare and insurance carrier guidelines related to documentation, coding, and medical necessity.
  • Analyzes and develops systems related to billing, collecting, and reporting of professional and medical services to ensure recovery of all professional and technical charges.
  • Trains new personnel in appropriate charge capture.
  • Provides reimbursement patterns and trend analyses to managers and physicians.
  • Provides on-going in-service training for billing personnel as well as clinical faculty including training in coding (CPT, ICD-10-CM, HCPCS).
  • Assists in resolving third-party denials received by Billing and Collections department and assists with reimbursement appeals and problems.
  • Prepares reports and analyses to include financial reports, setting forth progress, adverse trends, and appropriate recommendations or conclusion.
  • Participates in meetings with subordinates to ensure compliance with established practices to new policies and to keep employees aware of changes and current standards.
Qualifications
  • Bachelor's degree from an accredited institution as approved and accepted by the University of South Alabama.
  • One year of medical coding or related experience. Directly related experience may substitute on a year-for-year basis for the required education.
  • Certification as a Certified Professional Coder within one year.

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