Provider Pricing Reimbursement Analyst(Medicare, Medicaid, Commercial)
Title: Pricing Reimbursement Analyst
Description: Hybrid Non patient facing environment
equipment provided
No expenses allowed Job Summary
Gathers and analyzes financial information in accordance with the provider's negotiated contract to determine correct configuration of the claims payment system(s). Knowledge of facility and physician reimbursement methods will be combined with data analysis and business decision-making abilities to determine correct configuration. Analyst will take the lead, and serve as a liaison on problem resolution for internal and external customers. Essential Functions
Highly skilled in provider and pricing set-up. Articulates payment models and standard reimbursement methods for all providers and products. Research issues related to problems arising from provider or pricing set up and/or procedures. Determine root cause and take necessary action to resolve. Ensure effective communication of resolution to appropriate leadership.
Facilitate the timely and accurate contract implementation by completing necessary paperwork for new fee schedules, PFP groups, risk pools, PHO extensions, etc., as well as working with operational areas for non-standard contractual commitments. Ensure necessary approvals are documented to facilitate execution of standard and non-standard contract templates.
Develop Health's fee schedule models and standards. Research issues related to problems arising from fee schedule set up and/or procedures. Determine root cause and take necessary action to resolve. Ensure effective communication of resolution to appropriate leadership.
Apply strong analytical skills and business knowledge to the investigation, analysis and recommendation of creative solutions to problems.
Communicates, collaborates and acts as a consultant to internal and external customers in order to resolve medium level complexity provider issues.
Performs routine audits to identify trends and factors contributing to performance of contracts. Maintain process related documentation as necessary to support results of audit, with effective communication and information exchange with internal and external customers.
Monitors, develops, and improves job procedures to ensure maximum effectiveness in process and resource time spent on job tasks.
Monitor government program websites for timely updates as it relates to medical billing changes, pricing changes which may include ensuring fees are loaded into appropriate fee schedules according to established procedures, etc. Qualifications
Required Associate's Degree Emphasis in health care, business management (or equivalent combination of education and experience).
3 years of relevant experience Knowledge of FACETS and OnBase Required
3 years of relevant experience Knowledge of provider reimbursement methods and concepts (Medicare, Medicaid, Commercial) and industry standard pricing guidelines Required
1 year of relevant experience Knowledge of UB92 or 1500 billing Preferred
3 years of relevant experience Experience in Microsoft applications including Word, PowerPoint, Excel Required
Title: Pricing Reimbursement Analyst
Description: Hybrid Non patient facing environment
equipment provided
No expenses allowed Job Summary
Gathers and analyzes financial information in accordance with the provider's negotiated contract to determine correct configuration of the claims payment system(s). Knowledge of facility and physician reimbursement methods will be combined with data analysis and business decision-making abilities to determine correct configuration. Analyst will take the lead, and serve as a liaison on problem resolution for internal and external customers. Essential Functions
Highly skilled in provider and pricing set-up. Articulates payment models and standard reimbursement methods for all providers and products. Research issues related to problems arising from provider or pricing set up and/or procedures. Determine root cause and take necessary action to resolve. Ensure effective communication of resolution to appropriate leadership.
Facilitate the timely and accurate contract implementation by completing necessary paperwork for new fee schedules, PFP groups, risk pools, PHO extensions, etc., as well as working with operational areas for non-standard contractual commitments. Ensure necessary approvals are documented to facilitate execution of standard and non-standard contract templates.
Develop Health's fee schedule models and standards. Research issues related to problems arising from fee schedule set up and/or procedures. Determine root cause and take necessary action to resolve. Ensure effective communication of resolution to appropriate leadership.
Apply strong analytical skills and business knowledge to the investigation, analysis and recommendation of creative solutions to problems.
Communicates, collaborates and acts as a consultant to internal and external customers in order to resolve medium level complexity provider issues.
Performs routine audits to identify trends and factors contributing to performance of contracts. Maintain process related documentation as necessary to support results of audit, with effective communication and information exchange with internal and external customers.
Monitors, develops, and improves job procedures to ensure maximum effectiveness in process and resource time spent on job tasks.
Monitor government program websites for timely updates as it relates to medical billing changes, pricing changes which may include ensuring fees are loaded into appropriate fee schedules according to established procedures, etc. Qualifications
Required Associate's Degree Emphasis in health care, business management (or equivalent combination of education and experience).
3 years of relevant experience Knowledge of FACETS and OnBase Required
3 years of relevant experience Knowledge of provider reimbursement methods and concepts (Medicare, Medicaid, Commercial) and industry standard pricing guidelines Required
1 year of relevant experience Knowledge of UB92 or 1500 billing Preferred
3 years of relevant experience Experience in Microsoft applications including Word, PowerPoint, Excel Required