Revenue and Reimbursement - Reimbursement Analyst - 40hrs

The Reimbursement Analyst is responsible for analyzing incoming payment information and other communications (from payers, physicians, and patients) along with applicable contract terms, reimbursement schedules, government regulations and internal policies.  The Analyst ensures that Connecticut Children’s Medical Center (CCMC) is paid timely and according to contracted terms for the services rendered.  Ensures that all actions taken are consistent with a broad variety of government regulations, contractual terms and internal policies and procedures.  Works under general supervision following established protocols and procedures.  The Analyst maintains confidentiality of all information.  This position reports to the Senior Regional Contracting Manager of the Revenue & Reimbursement Department.

• Reviews payer payments; researches and resolves hospital payment discrepancies and ensures contractual rates received by way of working Epic work queues.
• Reviews payer policies as communicated.
• Regularly monitors underpaid hospital claims to ensure that they are brought to full resolution.
• Coordinates and leads monthly payer calls including appropriate staff ensuring agenda and spreadsheets are shared in a timely manner.
• Identifies HB contract proration issues and documents accordingly.
• Trends proration issues and quantifies for prioritization.
• Manages all HB Payer Variance W/Qs within EPIC.
• Participates in a variety of activities to enhance billing and collection efforts related to third party reimbursements.
• Determines whether or not remaining claim  balance  should be written off or referred to higher level of management for write-off decision.
• Assists with ad hoc reimbursement requests by utilizing RAD reporting, contracts and fee schedules.
• Other duties as assigned by management.
• Demonstrates cultural sensitivity in all interactions with patients/families and co-workers.
• Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CCMC STANDARDS.
   

Education and Experience Required:

• Education Required: Associates degree required from accredited college or university or equivalent experience.
• Experience Required: Three to Five years of healthcare revenue cycle or finance experience.

Education and Experience Preferred:

• Preferred education & experience. Bachelor’s preferred or equivalent experience

License and/or Certification:

• N/A

Knowledge, Skills, and Abilities:

Knowledge of:

• ICD-10, CPT, HCPC, Medical Terminology.
• MS Word and Excel.
• Insurance regulations and reimbursement policies.
• EPIC HB Reimbursement Contracts.

Skilled at:

• Must possess excellent interpersonal, communication, problem-solving, and organizational skills.
• Detail oriented.
• Excellent analytical skills.

Ability to:

• Analyze data, identify errors & resolve problems in a timely manner.