Position Summary:

The Senior Reimbursement Analyst ensures coding practices comply with government guidelines and managed contractual care agreements to receive accurate reimbursement. This person will help maintain coding systems to ensure compliant billing and assist with new and existing lines of services reimbursement analysis.

Primary duties & responsibilities:

Coding Support

• Collaborating with the Coding Manager maintains resource guides for procedures and injections in the office and ambulatory surgery centers to ensure standard and compliant billing.
• Responsible for maintaining all scenarios where a contractual agreement alters how an insurance carrier should be billed to avoid unnecessary denials and maximize reimbursement in a compliant manner.
• Validates and updates coders software to ensure services are compliantly billed based on government guidelines and payer contractual agreements.
• Works with vendors, coding leadership, and Managed Service Organization (MSO) partners to determine if services are billable under current contractual agreements.
• Manages the communication of contract updates and changes to relevant stakeholders.
• Works collaboratively with the RCM leadership and Physicians on investigating and setting up new provider service lines.
• Prepare for negotiations with payers to establish fee schedules for the new service line.

Reimbursement Analysis

• Understands payer rate methodologies and their impact to the coding workflow.
• Collaborates with UUG payer contract negotiators.
• Reviews the financial impact of different scenarios to inform clinical decision-makers of options based on a complete analysis of both coding and contractual impacts.
• Interprets all contract summaries and rates for contracts negotiated on behalf of Joint Venture (JV) partner entities.
• Validates how new contracts/contractual changes impact revenue based on potential coding changes.
• Investigates trends in coding/contractual denials to validate/improve current billing practices.
• Interprets payer policy regarding reimbursement coverage and educates the Providers, Pre-Certification, Coding, and Accounts Receivable (AR) teams.
• Educates AR team and partners on best coding/contractual-related appeals practices.
• Maintains AR-related systems/resources that inform the staff how to address AR coding/contractual denials.

Corporate (MSO) Support

• Facilitates communication between UUG and JV partners to allow both parties to make mutually beneficial decisions.
• Supplies pertinent updates to MSO partners on reimbursement inquiries to complete the above duty.
• Ensure appropriate billing practices are in place to conform to contract terms, including payer coverage guidelines.

Qualifications:

• Bachelors degree in healthcare administration, business, or other related field or equivalent required.
• Five years of management experience with progressive experience in coding, medical billing, and credentialing. Urology/Ambulatory Surgery Center experience preferred.
• Experience in the revenue cycle management of a multi-site healthcare delivery system, including ambulatory surgical centers.
• Has a successful track record of collaborative leadership of a management team to achieve strategic objectives as well as to ensure quality services and compliance with relevant contractual and regulatory requirements.

Knowledge, Competencies & Skills:

• Superior leadership, problem-solving, team building, and decision-making skills.
• Exceptionally well-organized and has superior written, verbal, and interpersonal communication skills.
• Proficient in computer software and database skills.
• Exceptional business and financial acumen.
• Excellent customer service skills
• Strong research skills and an in-depth understanding of financial analytics and legal agreements.
• Exceptional negotiation, persuasion, and judgment skills.
• Attention to detail, thoroughness, and mathematical abilities.
• Requires a strong ability to prioritize multiple initiatives and assigned tasks.
• Ability to type 40 words per minute.
• Excellent knowledge of computer databases with experience using Microsoft Office 365 and outlook.