Overview
This remote position involves analyzing and monitoring claims audit data across multiple platforms to ensure accurate and appropriate reimbursement to healthcare providers. The role includes identifying payment variances and collaborating internally and externally to resolve discrepancies.
Responsibilities
- Analyze and adjust/reprice claims to ensure reimbursement aligns with contractual agreements and payer guidelines
- Establish and maintain accurate pricing structures and rules for competitive and profitable pricing strategies
- Identify errors in reconciliation files across multiple work streams, business units, and external partners
- Perform contract and reimbursement variance analysis
- Analyze claims data to detect contractual overpayments and billing errors
- Assist department and leadership in obtaining complex information from financial, clinical, and operational systems
- Stay current on billing protocols, federal and state regulations, and internal procedures affecting processing
- Provide subject matter expertise on billing and coding guidelines and regulations
- Use internal and external billing protocols for repricing bills to achieve cost savings
- Identify trending opportunities related to policies and procedures to improve efficiency and accuracy
- Maintain detailed knowledge and documentation of all analysis and data sources within the department
- Analyze all forms of Revenue Cycle transactions
- Run standard Revenue Cycle and operations reports to address inquiries from stakeholders including department managers, vendors, and physicians
- Produce daily, monthly, and annual evaluative and statistical reports analyzing variance drivers to ensure data integrity
- Evaluate client data integrity and support Product and Account Management teams with trend analysis of payment and data variances
- Ensure strict confidentiality of all medical records, PHI, and PII
- Perform additional duties as assigned
Requirements
- Ability to work independently with strong critical thinking skills
- Detailed knowledge of pay reimbursement methodologies
- Strong understanding of claims processing, ICD-10 coding, and DRG validation (if applicable)
- Comprehensive knowledge of healthcare revenue cycle and claims reimbursement
- Proficiency in MS Office (Word, PowerPoint, Excel, Outlook), Windows OS, and Internet
- Strong analytical and problem-solving skills
- High attention to detail and ability to deliver results in a fast-paced, dynamic environment
Education and Experience
- Minimum 3 years of relevant experience or equivalent combination of education and work experience
- Experience in claims repricing, pricing configuration, or provider maintenance required
- High School Diploma or equivalent required
- Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
Compensation and Benefits
- Pay range: $19.21 - $28.73 per hour, determined by factors including location, skills, experience, qualifications, and market conditions
- Salary level may be adjusted based on assessment during the interview process
- Comprehensive benefits package for full-time employees including Medical (HDHP) with Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off
Location
- This is a remote position