Analyst 3 - Special Payor

UVA Health Charlottesville , VA 22901

Posted 7 months ago

The Analyst III reviews Single Payor Contracts, Grants, Special Payor Accounts, and government agency accounts. The individual works with the legal department for review of contracts, the Transplant Office for purposes of determining appropriate billing of services, Patient Financial Services for billing and collection of payments.

  • PRINCIPAL DUTIES AND RESPONSIBILITIES:

Essential functions of the job (specific duties vary depending on department):

  • Inputs data into physician billing system from claim edits.

  • Responds to inquiries from patients, clinical departments, and third parties via telephone, written correspondence and personal contacts.

  • Analyzes accounts to ensure accurate patient billing data and provides necessary follow up to assure effective collection.

  • Adds/corrects registration, insurance, and demographic data in physician billing system to ensure accurate records.

  • Views Medical Center system data to obtain additional billing information and compares records for insurance purposes.

  • Identifies charges that need discounts, including contractual, agency, and other adjustments according to established procedures Determines appropriate adjustment amount, provides necessary supporting documentation, obtains approval, and keys adjustment.

  • Works closely with Medical Center billing staff to ensure timely and accurate payments.

  • Works with Planning and Analysis to determine proper payment allocation for single payor agreements.

  • Retrieves medical documentation, reviews coding, and files claims to obtain payment.

  • Follows up with third party carriers to resolve issues and obtains payment by coordinating resolution to denied, claims to ensure timely collections.

  • Reviews and takes action on accounts that are not resolved within the expected contract timeframe

  • Reviews and interprets contracts for the purpose of billing single payor accounts, transplants and other special arrangements established by management and clinical departments.

  • Creates new special payor accounts.

  • Accesses HAL and STRANDS through the transplant center to obtain information regarding status and billing of transplant charges.

  • Works with the School of Medicine Clinical Trials Office for the purpose of accurately billing grant services.

  • Reviews monthly billing statements to assure accurate billing to special payor accounts.

  • Work with the Athletic Department to assure proper billing of services for UVA athletes to include services billed from the Athletic Training Room.

  • Receives, reviews and processes hospital and physician MDA claims according to specified authorization. Reallocate package payments based on RVU's.

  • Manages work through use of multiple systems.

  • Participates in special meetings, projects as required.

  • Other duties as identified by Unit Coordinator, Supervisor and/or Manager, Billing & Collections.

MINIMUM REQUIREMENTS

REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities):

Education:

  • High School Diploma or GED
  • Some college courses preferred
  • CPC helpful

Experience:

  • Two years relevant office experience

  • Experience in insurance preferred

Skills:

  • Word processing and spreadsheet skills required

  • 10-key calculator experience preferred

  • Experience utilizing billing application software required

Strong math skills

The University of Virginia, including the UVA Health System and the University Physician's Group are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.


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Analyst 3 - Special Payor

UVA Health