Day (United States of America)

Recovery Reimbursement Analyst

This individual serves as an operational subject matter expert ensuring that Halifax Health receives appropriate payment for delivered services. Works as part of a team as well as independently to ensure identified payment variances for managed care, government contracts and other various payers are resolved in a timely and compliant manner. Key focus of the Recovery Reimbursement Analyst is reimbursement analysis, payment resolution with timely follow up on all assigned accounts, appropriate account adjustment and comprehensive documentation in the applicable hospital systems.   This role is responsible for working with diverse groups within the organization and contracted payers to analyze and understand underpayment root causes and to develop thorough collection techniques to contribute to overall payment resolution. This requires a thorough understanding of Patient Financial Services functions (hospital patient access requirements, claims processing, collections and remittance posting) in addition to hospital contract specifics.   The Recovery Reimbursement Analyst is responsible for working to identify and then resolve systemic issues that cause revenue capture inefficiencies. The individual will perform specific areas of review, follow up, recovery and account resolution for third party payer underpayments and denials of hospital patient accounts through the use of streamlined collection techniques and appeals.

- High School Diploma or GED equivalent required.
- AS/AA degree in Accounting or Business Administration highly desired.
- Past work experience of at least 2 to 5 years revenue cycle either in billing, reimbursement or collections including but not limited to Medicare, Medicaid and Managed Care reimbursement methodologies is required.
- Independent and self directed.
- Organizes, prioritizes and coordinates multiple activities and tasks.
- Works with initiative, energy and effectiveness in a fast paced environment.
- In depth knowledge of insurance and governmental programs, regulations and billing processes (e.g. Medicare and Medicaid), for managed care contracts is required.
- Must be able to interpret contract language and various factors that make up payment methodologies including but not limited to:  DRG, APC, ASC, Fee schedules, per diems, carve outs, stop-loss provisions, cost thresholds, outliers, bundling, percent of charges, Implantables and case rates.
- Must be able to perform accurate calculations and have analytical reasoning skills.
- Must be able to work independently and on teams as needed.
- Experience with Contract Management systems preferred.
- Basic computer skills are required. Knowledge of Excel worksheets is essential.
- Strong mathematical skills required.
- Strong written and verbal communication skills and organization abilities are required.
- Accuracy, attentiveness to detail and time management skills are paramount to success.
- Must be able to work in a collaborative environment.
- Evaluates variances on paid claims.
- Performs contract analysis to validate accuracy of programmed contract rules.
- Works independently to identify collectable underpaid amounts through appeal or reconsideration.
- Ensures reimbursement and follow up is accurate, timely and compliant.
- Initiates timely appeals and reconsiderations with payers by telephone, letter, email or other electronic media or spreadsheets.
- Perform follow up with regulatory agencies as may be required for challenged claims.
- Track and document underpayment reconsideration and appeals in contract management system.
- Accurately calculates and enters adjustments into the host system while appeals are pending. Ensures that batches are finalized at the close of business daily.
- Documents all activities in the contract management system.
- Assists with appeals for technical denials as needed.
- Addresses aged accounts in a timely manner to reduce Accounts Receivables and maximize reimbursements due under contract.
- Assists in efforts to maintain contract/ underpayment calculation integrity by monitoring system issues and serves as a liaison between Managed Care Recovery and PFS IT.  
- Participates in team development projects and offers solutions to identified payer issues.
- Mentors new team members as directed.
- Assist other departments perform claim analysis as needed.
- Assimilates documentation to support reconciliation or appeal.
- Identified and reports data and collection trends/ barriers to claim resolution.
- Meets and/or exceeds production goals as defined.
- Other duties as assigned.