REVENUE RECOVERY ANALYST – CONTRACTING AND MANAGED CARE

  • Memorial Health System
  • Marietta, Ohio
  • Aug 05, 2022
Healthcare IT

Job Description

REVENUE RECOVERY ANALYST – CONTRACTING AND MANAGED CARE Marietta Memorial Hospital, 401 Matthew Street, Marietta, Ohio, United States of America Req #2869 Thursday, July 21, 2022 Status: Full Time – 80 hours Hours: Monday-Friday - 8am-4:30pm   In an environment of continuous quality improvement, the Revenue Recovery Analyst will play a key role in underpayment recovery by reviewing claim and payment information through a contract management and underpayment identification system to identify potential individual underpayments and underpayment trends. Identified potential underpayments and trends will be analyzed and screened to remove false positives, in order to accurately and efficiently pursue lost revenue. The Revenue Recovery Analyst acts as a liaison between various Revenue Cycle Departments to implement processes to prevent future revenue loss. This position is critical in the recovery of accurately identified underpayments and lost revenue. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times. Job Requirement: An Associates degree (or equivalent experience) in a healthcare-related field is required Bachelor degree (or equivalent working experience) in a healthcare-related field is preferred Computer skills (word processing, spreadsheet, graphics, and database software applications) Strong quantitative, analytical and organization skills Strong negotiation skills Proficient in payment review systems, hospital information systems and coding methodologies Ability to understand medical records, hospital bills, and the charge master Ability to understand all ancillary department functions for the facility Ability to understand complex insurance terms and payment methodologies Ability to effectively negotiate with insurance carriers and customers Ability to utilize and understand computer technology Ability to communicate orally and in written form Team-oriented with strong interpersonal skills Job Functions: Review payer contracts and maintain the contract management and underpayment identification system based on the terms of the contracts including, but not limited to, rate and fee schedule adjustments and insurance policy updates to provide for accurate estimation of organization's accounts receivable in accordance with contract terms. Routinely analyze the contract management and underpayment identification system reports against contractual documentation and payer websites for accuracy of setup. Find missed revenue opportunities by analyzing reimbursement discrepancies and develop recommendations to resolve discrepancies, implement corrective action as necessary and then appropriately communicate changes to impacted parties. Initiate and follow through with all relevant parties to ensure corrective actions are implemented to prevent future loss in revenue. Act as a liaison between the various Revenue Cycle departments on process improvement efforts which are based on data results impacting financial outcomes. Maintain effective relations with payers related to managed care contracts. Provide reporting of payment variance reviews. Utilize independent judgment and exercise discretion to ensure timely review and auditing of underpaid claims. Analyze, collect underpayments and resolve claims with discrepancies from expected payment to ensure payers are in payment compliance with their contracted terms. Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third party payers. Work directly with payers to recover payments. Identify patterns, trends, and root-causes in billing issues and payer performance. Provide information on global payer issues and assist in preparing utilization data to work with payers on collecting additional funds in most efficient manner possible (spreadsheet, project, mass rebill, etc..). Consistently maintain productivity and accuracy standards in highly challenging environment. Assumes all other duties and responsibilities as necessary. Compensation Details:  Education, experience, and tenure may be considered along with internal equity when job offers are extended. Minimum hiring rate for this position is listed below. Benefits Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees.    Medical Insurance – PPO & HDHP Dental and Vison Insurance Health Saving Account Flexible Spending Account Dependent Care Pension Plan – Defined Contribution 403b Retirement Plan Voluntary Life Insurance Short-Term & Long-Term Disability Vacation Time Sick Time Holiday Pay & Premium Shift Differential Tuition Reimbursement Tuition Repayment Performance & Market Increases Relocation Package, if applicable   This position is patient facing and/or requires close interaction with other employees, or other factors that would compel mandatory vaccinations unless otherwise approved for a medical or religious exemption.   Memorial Health System is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at https://www.ocio.usda.gov/document/ad-3027, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. Other details Job Family Non-Clinical Job Function Frontline Employee Pay Type Hourly Min Hiring Rate $21.04 Apply Now