Contract Management Reimbursement Analyst -USA Health Shared Services, Business Office Administration
USA Health Mobile, Alabama, United States
Hospitals and Health Care · 1,001-5,000 employees
About the role
The analyst will manage and load managed care contracts, ensuring accurate reimbursement methodology and compliance with coding and billing regulations. They will also perform trend analyses, resolve third-party denials, and train staff on charge capture and billing standards.
What they look for
Requirements
Candidates must hold a Bachelor's degree or equivalent experience, with at least one year of medical coding or related experience. A Certified Professional Coder (CPC) certification is required within one year of employment.
Full description
Overview
USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.
Responsibilities
- Loads executed managed care contracts into the contract management system
- Updates contracts with scheduled rate changes as of effective dates
- Builds new service definitions and implements new reimbursement methodology into the system as required
- Consults with contract negotiators to recommend precise language and meaning of contracts
- Ensures that the contract template accurately calculates the terms of the contract as negotiated
- Monitors periodic changes in recognized coding schemes (ICD, CPT, and DRG) to anticipate impacts on contract language, calculations and reimbursement of specific contracts using those codes
- Reviews cases and writes appeals
- Assists in coordinating and maintaining the reimbursement program for USA Health System to ensure compliance with current payments, rules and legislative regulations that impact billing and collections processes
- Monitors and ensures compliance with Medicare and Medicaid documentation guidelines for USA Health
- Monitors and evaluates current reimbursements/payment rules and ensures legislative and regulatory changes impacting USA Health
- Communicates to staff and departmental billing personnel any changes impacting billing
- Develops techniques for effective analyses of billing collection efforts
- Ensures compliance with Medicare and insurance carrier guidelines related to documentation, coding and medical necessity
- Analyzes and develops systems related to billing, collecting and reporting of professional and medical services to ensure recovery of all professional and technical charges
- Trains new personnel in appropriate charge capture and provides on-going in-service training for billing personnel
- Provides reimbursement patterns and trend analyses to managers and Directors
- Assists in resolving third party denials received by Billing and Collections department and assists with reimbursement appeals and problems
- Prepares reports and analyses to include financial reports, setting forth progress, adverse trends and appropriate recommendations or conclusion
- Participates in meetings with subordinates to ensure compliance with established practices to new policies and to keep employees aware of changes and current standards
- Works claim edits and work queues within practice management system.
- Identifies and resolves claim issues related to coding, documentation, payer requirements, and system configuration.
- Completes all mandatory department, educational and hospital requirements
- Adheres to current Infection Control and Safety Standards
- Regular and prompt attendance
- Ability to work schedule as defined and overtime as required
- Related duties as assigned
Additional Information
Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.
Qualifications
- Bachelor's Degree from an accredited institution and 1 year of medical coding or related experience Required
- Directly related experience may substitute on a year-for-year basis for the required education Required
- Certification as a Certified Professional Coder within 1 Year Required
- Comparable combination of education and experience may substitute for the above requirements.
Equal Employment Opportunity/Affirmative Action Employer
The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis. EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.
