Clinical Practice Association Third Party Reimbursements is seeking a Reimbursement Analyst who will be responsible for monitoring third party professional fee contractual allowances, analyzing reimbursement variances and making recommendations to the Director, Third Party Reimbursements regarding payment discrepancies.
Specific Duties & Responsibilities:
Creates and maintains variance identification systems including loading and maintaining third party fee schedules and payer profiles.
Monitors and tracks contract reimbursement performance and reports terms of concern negatively impacting payments to Director of Third Party and departments affected.
Maintains a thorough knowledge of contract reimbursement requirements, invoice processing, payment posting procedures, and insurance carrier billing and payment policies.
Participates in meetings with Third party payers and departments to recoup underpayments and resolve escalated claim issues. Discusses ongoing trends and issues regarding the administration of managed care contracts, payment irregularities and reimbursement trends.
Manages the collections of Single Case Agreements and maintains accounts receivable balances within departmental standards.
Manages the collections of Out-of-State Medical Assistance claims and maintains accounts receivable balances within departmental standards.
On a daily basis, provide professional consultation and assistance regarding industry standards, regulations, and payment operations, to department staff, Production Unit Managers, Associate Directors, Directors, and Senior Directors within the SOM and JHBP to improve receivable collectability and staff efficiencies.
Develop and maintain liaisons with Third Party Payer representatives through face to face meetings, telephone interactions and written correspondence to enhance contractual compliance, payment accuracy and understanding of carrier system workflows and policies.
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Utilize internal and external resources including EPIC, electronic medical records, payer websites, and other resources to facilitate efficient operations, issue resolution, and education.
Excellent communication and customer service skills with the ability to work well under pressure and provide guidance on industry standards, regulations, and payment operations for patients, physicians, administrative staff, team members and payers in a high volume medical services environment.
Possess detailed knowledge of medical policies, medical terminology, and National Correct Coding standards including CPT's, diagnosis codes and all modifiers that affect billing and the revenue cycle operations.
Strong working knowledge of standard invoice processing/payment posting procedures and generally recognized PBS billing applications and policies.
Knowledge of managed care contracts, reimbursement policies and JHU variance monitoring systems as applicable.
Professional & Personal Development:
Participates in on-going educational activities.
Assists in the training of staff.
Keeps current of industry changes by reading assigned material on work related topics.
Completes three days of training annually.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
Minimum Qualifications (Mandatory):
Bachelor's Degree in related field required.
Five years' experience in professional fee billing and collections with a focus on third party contract reimbursement and management required.
Additional job-related experience and additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula.*
* JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for the required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
** Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
Special Knowledge, Skills & Abilities:
Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
Strong analytical skills.
Advance level in Microsoft Excel.
Requires excellent independent research skills.
Requires analytical and decision-making skills to solve complex problems.
Able to sit in a normal seated position for extended periods of time.
Able to reach by extending hand(s) or arm(s) in any direction.
Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard.
Able to communicate using the spoken and written word.
Able to see within normal parameters and to hear within normal range.
Able to move about.
Able to lift minimum weight, 10 lbs.
Classified Title: Reimbursement Analyst Role/Level/Range: ATP/04/PD Starting Salary Range: $59,870 - $82,250 annually (commensurate with experience) Employee group: Full Time Schedule: M-F 8:30am-5:00 pm Exempt Status: Exempt Location: Hybrid/JH at Middle River Department name: SOM Admin CPA Third Party Reimbursements Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.
Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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