Hospital Reimb. Contract Analyst - Corporate Revenue Integrity (Remote)

Position Summary : Coordinates processes integral to third party contract management. Conducts audits, monitors, and reports payor performance. Analyzes billing and collection data and develops management reports. Adaptability to current in-house billing system is fundamental. The requirement of this position includes but is not limited to the essential functions listed. Experience: Minimum of five (5) years in the health care accounts receivable field is required with proven capabilities in a leadership role. Must understand clinical and financial data (i.e. CPT, revenue codes) and comparing to third party billing compliance regulations. Education: Bachelor’s Degree in Accounting, Business Administration (or another relevant program) required. Three (3) years of appropriate experience analyzing financial data & developing management reports. Significant and/or extensive experience (minimum of 5 years) in the management of health care financial data may be considered in lieu of the degree requirements. Knowledge of Microsoft products, and working knowledge of an electronic health and financial record system. Technical proficiency required. An associate degree in Business Administration, or related field is required or high school graduate with five (5) years of proven practical experience in the health care accounts receivable field. Essential Functions:

• Create reimbursement rules (contract profiles) within the current in-house billing system. Maintain the profiles to reflect new and/or updated contracts. Perform quality testing for various rate schemes as they are installed.
• Participates in payor contract meetings and payor discussions regarding third party payor performance related issues. Provides information regarding payor performance, contract system requirements and/or limitations.
• Responsible for the following organizational workflows and metrics: contractual adjustment levels, variance levels and work queues, and contract performance and maintenance.
• Monitor insurance payments and identify variances from negotiated contract rates. Communicate with insurance companies to assist in adjudicating patient accounts and inform staff of significant/ trending payor discrepancies as needed.
• Maintain an Issues Profile of major contracted insurance companies, for use during future contract negotiations.
• Conduct at minimum quarterly third-party performance audits and prepare audit reports and support documentation.
• Prepare comprehensive Monthly Revenue Cycle Management Report and other reporting as needed to support revenue cycle operations.
• Complete analytics related to the financial performance of corporate revenue cycle specific departments.
• Participate and comply with RA update requirements related to Epic updates. May include but not limited to rule updates, payor master updates, etc.

Other Duties

• Conduct, at minimum, bi-annual contract education for the CRC staff requiring payor contracting and/or performance training.
• Prepare and submit the quarterly Medicare Credit Balance Report.
• Demonstrates age specific communication skills.
• Other duties as assigned.

Joining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you’ll find staff members who have committed themselves to serving the community. The Guthrie Clinic is an Equal Opportunity Employer. The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine. Apply tot his job Apply To this Job