Payment Compliance Analyst

Job Description

Essential Duties and Responsibilities include the following. Other duties may be assigned:

• Identify trends in underpayment/overpayments, denials, revenue opportunities and revenue leakage

• Evaluate trends and works towards resolution and improvement of revenue cycle processes

• Interpret contract reimbursement and provide feedback to management staff as required

• Manage underpayment appeals, account follow-up and payer relationships

• Compile and analyze data to make recommendations

• Work with financial and clinical departments collaboratively

• Review contract validation, updates and interpretation

• Resolve underpaid claims in an effective and timely fashion

• Review payer policies for impact on reimbursement

• Present data to various end users

• Compile and validate account analysis prior to distribution

• Research and identify payment discrepancies from various sources

• Other duties as assigned

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Highly organized

• Initiative to work independently

• Proficient with telephone and email communications

• Basic understanding of medical coding systems affecting the adjudication of patient accounts in EDI or UB04 form,

including: ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures

Reasoning Ability:

The analyst must have the ability to define problems collects data, establish facts, and draw valid conclusions. The analyst must have the ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Computer Skills:

To perform this job successfully, an individual should have:

• Interest and aptitude in computer-based applications for complex business processes involving Boolean expressions,

symbolic representation and procedural logic

• Required PC competencies including intermediate Microsoft Office skills

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience/Skills:

• High School graduate or equivalent

• Minimum of 1 (one) year of hospital revenue cycle experience or equivalent work experience

• Excellent interpersonal skills required to communicate with direct staff and internal/external customers

• Must possess excellent time management and organizational skills with great attention to detail

• Maintain applicable continuing education requirements

• The ability to work on multiple projects/initiatives at a time

INDSS