Position is responsible for resolving systemic billing issues that cause claims to be rejected by payers. Responsibilities include root cause analysis, process improvement recommendations and regular reporting.
- Conducts root cause analysis to isolate and correct system billing errors regarding coding and unique insurance company billing requirements.
- Analyzes state insurance regulations to determine specific billing requirements for each state where the business unit has operations.
- Develops systems for systematic monitoring and analysis of outcomes of billing and collections processes.
- Maintain payer contracts in contract management software to ensure system is applying proper claims reimbursement methodology for accurate payment from both government and commercial payers.
- Develops and generates information critical to the ongoing measurement, operation and improvement of the revenue cycle.
- Compiles and analyzes contractual allowances in relationship to insurance contracts and government payor arrangements.
- Provides monthly analysis to assist management with an understanding of net revenue realization rates.
- Maintains and improves revenue collection, payment information and reporting with the use of the payer contract management system.
- Performs analysis related to impacts of changes in government payment regulations and models contract negotiations for commercial payers.
- Associates degree or equivalent experience
- 4+ years experience in medical billing, collections or related field
- Highly analytical with strong systems orientation
- Good understanding of accounting principles
- Strong communication skills; presentations are clear and concise
- Good understanding of insurance industry, key players, state & federal government contracts
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