Position Overview:

Reporting to the Director of Reimbursement, the Payor Reimbursement Analyst is responsible for reviewing payer contracts and payment policies, fully understanding, summarizing, and distributing the contract summaries to the team in a format that is easily comprehended. They will also provide direction in the development of critical RCM initiatives and goals, leading and managing key projects including, ensuring maximum reimbursement that is accurate and timely.

Responsibilities:

• Ensures Managed Care Contracts are loaded timely and accurately into the appropriate systems.
• Provides timely and accurate contract summaries, highlighting payer reimbursement methodologies, rates, and key areas necessary for accurate claims processing.
• Create, disseminate, and participate in the presentation of educational materials in relation specific to contracts and reimbursement strategy.
  • Leads the effort with payer specific training of new hires and continuing payer specific education of existing team members
• Stay current on industry and insurance trends in the reimbursement and managed care areas and the application of industry best practices that are aligned with reimbursement and commercial strategies.
• Proactively participates in activities that improve department operations and/or support to the department for quality improvements
• Identify system contractual issues and implements appropriate tasks to bring AR closer to true expected reimbursement
• Maintains library of information/tools related to documentation guidelines and communicates this information to applicable teams
• Assist in determining reimbursement approach, strategy, and reimbursement trend awareness.
• Supports Revenue Cycle Operations in evaluating future reimbursement initiatives along with tracking, reporting and providing feedback.
• Procures and maintains Medicare coverage across all LCDs
• Monitor important Medicare and private payer reimbursement policies that may have a significant impact on ASC reimbursement.
• Other tasks, projects, and training as needed.

Requirements:

• This position requires extensive experience in understanding Ambulatory Surgical Center contracts and reimbursement.
• Extensive knowledge of health insurance plans (Medicare, Medicaid, Managed Care, PPO, POS, Self-funded, TPAs, Workers Comp, etc.).
• Vast knowledge and technical competence in Contract Administration.
• Knowledge of typical payer guidelines related to billing, both paper and electronic claims
• Understanding of revenue cycle processes, cause and effect on A/R and cash results
• Ability to analyze data and develop systems to accurately control financial activity within a surgical center setting.
• Excellent written and verbal communication skills
• Proficient knowledge Word, Excel, PowerPoint and Outlook
• Experience with Vision and/or AdvantX software is helpful