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