Description

Job Title:                                Analyst, Reimbursement

Company:                              Tegria Revenue Cycle Management (Tegria RCM)

Department:                          HB Insurance-Prov Payer Yield – Management & Admin

Leader:                                   Director, Revenue Cycle Services

FLSA Status:                         Salaried/Exempt

Work Location:                     Remote within U.S.

Travel:                                    No travel required

Compensation:                     $38,400 - $83,000

Overview

A Reimbursement Analyst is responsible for the overall maintenance of contract management module, contract interpretation, variance reporting and reimbursement analysis. This role will develop and maintain variance reports and perform analysis of underpayments from insurance payers. Identifies and stays current on insurance industry practices and governmental rules in order to make decisions about changes in reimbursement rates.

Responsibilities include: 

• Coordinates the maintenance and updates of all computer software tables and programs related to Reimbursement and variances
• Performs periodic reimbursement audits to determine if the system is being used to its full potential and to ensure contract compliance
• Complete written report of audit findings utilizing standard report formats
• Performs self-review of audit reports for tone, content, grammatical and technical accuracy, and completeness in accordance with department reporting standards
• Coordinates the preparation of reports in a timely and accurate manner
• Maintains up-to-date knowledge of current and emerging information regarding our payer contracts, Medicare legislation, regulations, market activity and industry trends and provides timely and effective communication of same to insurance leaders
• Researches and analyzes issues using tools such as the Internet, Medicare bulletins, CMS Web site and coding guides
• Provides training to the team on system usage and upgrades and outcomes of payment variance reporting.
• Maintains independence and objectivity related to assignments
• Other duties as assigned

Qualifications

• Bachelor’s degree in computer science, business or accounting or other applicable field or equivalent education / experience
• 5 years of experience in hospital/physician’s business office with reimbursement exposure
• Demonstrated experience with Monarch and Crystal reports
• Thorough knowledge of CPT-4 and ICD-10 coding and RVU-based reimbursement methodology and payer contracts
• Strong analytical capabilities required with demonstrated organizational and problem-solving ability
• Attention to detail and capability to apply discretion and sound judgment in managing complex processes, decisions and handling sensitive information.
• Exceptional communication, listening, coaching, facilitation, and conflict resolution skills.
• Ability to relate well to all kinds of people, up, down, and sideways, inside and outside the organization.
• Strong computer skills including experience using Microsoft Excel, Word, PowerPoint, Outlook, OneDrive
• Acceptance of difficult jobs willingly along with normal workloads
• Ability to work independently with minimal supervision and collaboratively as part of a team 

Physical Requirements:

The physical demands described 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.  Listed below are the physical requirements required while performing the duties of this job.

• The employee is regularly required to: stand; sit; talk; hear; use hands and fingers to operate a computer and telephone keyboard; and reach, stoop and/or kneel to install computer equipment
• The employee must have the specific vision ability to complete close vision requirements due to computer work
• The employee is required to be able to complete light to moderate lifting 

Our Commitment to Diversity, Equity, and Inclusion:

We welcome and respect the variety of experiences, viewpoints, and cultural backgrounds that everyone brings to our workplace. Tegria RCM makes every effort to promote a workplace where leaders model inclusive behaviors and individuals feel respected, valued, and empowered.  Together, we promote and sustain an inclusive workplace where people feel a sense of belonging