Job Description

OF POSITION:

Reimbursement Analyst is responsible for evaluating all aspects of the claims escalation team to maximize processes, evaluating and overturning denials to provide denial trend information to leadership, and providing team management.

SUPERVISION: Reports directly to the Collection Supervisor

RESPONSIBILITIES AND DUTIES:

• Oversee daily collection process; provide employee training and development evaluations, report daily employee progress/performance
• Compose, distribute, and analyze collection productivity reports daily and assign tasks to maximize the quality of productivity
• Create procedures that effectively demonstrate proper collection techniques and train all team members to be in compliance
• Evaluate and interpret Payor contracts to identify error payments, underpayments, and maximize insurance reimbursement.
• Maintain updated information regarding changes to Insurance Carrier policies and communicate to leadership, departments, and collection team
• Effectively evaluate aged denials to determine balance adjustments and/or if additional escalation is needed
• Reviews weekly payment reports to satisfy accounts, resolve discrepancies, and/or track trends.
• Communicate with outside vendors, repricing companies and negotiation service suppliers to facilitate correct claim payments
• Negotiate Single Case Agreements (SCA) or Out of Network Agreements (ONA) to ensure acceptable and timely reimbursements on accounts.
• Effectively evaluate AR to identify problematic processing trends and communicates finding to various Departments and Managers for resolution
• Utilizes system resources in order to compile reports and provide accurate feedback regarding Denials and Underpayments to Administration.
• Accurately evaluates each account in order to determine what is needed, what is left outstanding, and what steps are necessary to resolve the account quickly.
• Properly utilizes productivity tracking mechanisms.
• Works at or above the weekly set productivity standard and completes tasks in a timely manner.
• Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.
• Documents all information in the System following the Clear Concise Consistent method.
• Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.
• Writes clearly and informatively.
• Edits work for spelling and grammar.
• Varies writing style to meet needs.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• High school graduate or GED certificate, required.
• Two to Four year degree or least four-year experience in Healthcare or related field preferred.
• Adequate keyboarding skills (40 words per minute typing rate); Basic computer skills.
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills including assertiveness and being proactive.

Physical Demands/Work Environment

• Work requires light duty lifting.
• Must be able to remain in a stationary position 50% of the time.
• Constantly operates a computer and other office machinery such as calculator, copy machine, and computer printer.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.

Working at Lake Charles Memorial Health System | Great Place To Work®