The Provider Reimbursement Coordinator is responsible for activities associated with developing programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Provider Reimbursement Coordinators support those who analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Other responsibilities may include involvement with fee schedule and contract template maintenance.
Develops programs, policies and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. Analyzes claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately. Reviews claim disputes to verify correct pricing and analyzes claim inquiry data to determine root cause of errors; recommends system changes, training and process improvements to prevent future errors. Works with both internal and external customers to identify and resolve complex problems. Assists company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Fee schedule and contract template maintenance is also included in this function.
Apply knowledge/skills to activities that often vary from day to day.
Demonstrate a moderate level of knowledge and skills in own function.
Require little assistance with standard and non-standard requests.
Solve routine problems on own.
Work with supervisor to solve more complex problems.
Prioritize and organize own work to meet agreed upon deadlines.
Work with others as part of a team.
Conduct research and analysis for allocation of provider refund checks
Responsible for conducting remedial bank transactions which may include; entry of write-offs, recoveries, and check activity (e.g., stopped payments, voids, reissues, etc.
Basic tasks are completed without review by other.
Supervision/guidance is required for higher level tasks.Reconciliation of claim check payments from the claims payment system (e.g., undeliverable, returned mail, provider refused to cash, etc)
Submitting requests for Accounts Payable checks as reimbursement for un-allocated voluntary provider refund checks
Review periodic reports indicating outstanding provider credit balances in an effort to identify providers best suited for direct contact
Maintain accurate records of collection efforts by completing supplied templates to report checks received that were or were not applied in the claims payment system
Documenting and resolving provider customer service issues and inquiries
Perform other duties as assigned
Moderate work experience within own function.
Some work is completed without established procedures
Entry of manual payment reductions into the claims payment system.
High School Diploma/GED
1+ year of experience with claims processes, workflows, and reporting management.
1+ year of previous experience with provider data or provider payment.
Intermediate (or higher) level of proficiency with Excel (i.e. use of formulas, pivot tables, use of existing reports, etc.).
Basic (or higher) level of proficiency with MS Word
Previous experience with FACETS
Previous experience in healthcare accounting
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