Himalayas
healthcare reimbursement specialistclaims managementmedical billinghealthcare revenue cyclerevenue recovery specialisthospital administrationinsurance underpayment analysthospital reimbursement analystinsurance underpayment recoveryhealthcare underpayment specialistrevenue cycle underpayment analyst
Job Description
What your impact will be:
PRIMARY DUTIES AND RESPONSIBILITIES(OTHER DUTIES MAY BE ASSIGNED)
- Identifya minimum of 25healthcare insurance underpaymentsfor hospitals’patient accountsper dayvia MEDHOST Contract Management application;identification of varianceunderpaymentswill includezero payments, full denials, line-item denials, billing corrections, updated billing coderequirementsand incorrect payor system setup.MEDHOST Variance & Denial Reports areutilizedtoassistwith identification of variances.
- Verify insurance payment for accuracy and compliance with contract terms and fee schedules.
- Identifyroot cause of insurance reimbursement underpayments and takeappropriate actionsto resolve payment variances;work efforts are to be focusedonidentification and recovery ofhigh dollar insurance underpayments, zero paymentsand trendingto increase reimbursements for the hospital.
- Utilize Contract Management Worklist reporting tofacilitateprompt identification of insurance variances.
- Review claims billed and insurance remits to research variances; claim review may include coding,billing,and discrepancies with patients’ insurance information.Collaborate with the facilities to send corrected claims and appeals.Ability to navigate within MEDHOST andcustomer’sclearinghouse systems toidentifyroot causes of variances.
- Notatevariance reason within patient accounts and update patient accountsutilizingpre-defined variance reasoncodesvia MEDHOST system.
- Contactinsurance providersregardingidentified underpayments and follow insurance payor guidelines to collectadditionalreimbursement on behalf of the facility.
- Continue to follow-up with insurance payors once the payor has verified the underpayment and account resolution isdeterminedbased on MEDHOST standard guidelines.
- Work accounts with variancesutilizinga broad range of collection approaches including telephone calls with individual resources, conference calls with a group of resources,presentations, screen sharing,written communication,electronic faxing, uploading information to payor websites,rebilling of claims, etc.
- Notatefollow-up efforts made towards the collection process on the patient accounts viaMEDHOSTsystem.
- Communicate variance identification and recovery updates to clients weekly/monthly.
- Prioritize activities to work variances and denialsin a timely manner.
- Collaborate with the MEDHOST Contract Management Build/Specialist teamregardingcontract build issuesidentifiedduring the underpaymentresearchprocess.
- Review underpayment andoverpaymentfalse variances with client to minimize future false variances.
- Maintain customer meeting agendas andfacilitatecustomer status calls; communication to include variance trendsidentified, weekly/monthlyvariancereporting, contracts & fee schedules needed tomaintainfacility’scontract builds and report information that may hinder Contract Management work.
- RequestassistancefromMEDHOST andfacility’s’leadershipregardingunsuccessful attempts to collect underpayments.
- Complete projectsassignedto improve operations within the team and to increase reimbursements for facilities.
- Assist others with projectsand provide trainingto team members and customersasneeded.
- Collaborate withfacilities andother MEDHOST teams for resolution of outstanding items.
- Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements as needed.
- Responsible for QMS procedures listed in QMS Procedure Crosswalk found in QMS Manual as applicable.
- Any other duties asdeemednecessary to provide quality service to MEDHOST customer base and CM team.
Wage:
$18-$28/hr
Administrative Duties:
- Accurately input/submitworked time by the required departmental deadlines.
- Maintain MEDHOST software applicationsutilized& industry knowledge through self-study and by attending training classes.
- Maintain in-depth knowledge of insurance payers and collection regulations.
- Attend andparticipatein team and departmental meetings.
- Respond to email, Microsoft Teams,and phone communicationsin a timelymannerand with professionalism.
- Ensure that all HIPAA Privacy and Security requirements and responsibilities are adhered to.
- Access protected health information (PHI)in accordance withdepartmental assignments and guidelines.
- Bookstravel in adherence to the companyand departmenttravel policy.
What will make you stand out:
Knowledge,Skillsand Abilities:
- Knowledge of hospital billing and revenue cycle terminology.
- Knowledge of revenue cycle processes affecting reimbursement, including intake, admissions, registration, billing, accounts receivable, collections, cash posting, payor logs, file maintenance, aging AR management, reporting, day-endand month-end closing.
- Understanding ofmedical terminology.
- Knowledge and understanding of Explanation of Benefits (EOB), contract language, and state/federal guidelinesrequired.
- Knowledge of working with Electronic Health Records or related healthcare systems.
- Skilled in makingaccuratearithmetic computations.
- Ability to understand and interpret reason for underpayments, or overpayments.
- Display excellent communication skills (verbal & written), good judgement, tact, initiative, and resourcefulness.
- Must be detail oriented, organized, and ability to multi-task.
- Ability todemonstratesupportiverelationshipswith peers,clients,partners,andcorporateexecutives.
- Demonstrate the ability to build andmaintainstrong internaland externalrelationships.
- Utilize critical thinking skills to resolveagedand problematic accounts.
- Mustbeflexiblewitha “cando” attitudeandcanremainprofessionalunderhighpressuresituations.
- Retain and protect confidential material.
What we're looking for:
Training and Experience:
- MEDHOST(HMS)Contract Management experience is a plus.
- 3years ormoreexperience incontract management or relevant hospitalrevenue cycleexperience.
- Follow directions and perform work according to department standards; work performed self-independently & team player.
- Sufficientcomputer skills in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned.
- Customer Serviceoriented.
Other Requirements:
- High Speed Internet access (minimum 300 Mbps download speed) and unlimited data
- Smart phone for Multi Factor Authentication (MFA) application
Originally posted on Himalayas
