Healthcare Reimbursement Analyst

POSITION SUMMARY

Identifies, analyzes, and monitors issues that affect net revenue, contractual allowances and adjustments. Performs research, audit, and analysis of payor and business data to help identify and understand variances and fluctuations in net revenue as well as a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. May perform submission of data requests for departments and outside agencies that are used for comparative analysis of AHCs performance and to comply with regulatory requirements. Maintains a thorough understanding of patient billing and accounting systems. Keeps current on third party regulatory changes; helps monitor Medicare/Medicaid and third-party settlements.

EXPECTATIONS

Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism and competence.

OUR CORE VALUES

• Excellence
• Integrity
• Sustainability
• Respect
• Compassion

ESSENTIAL SKILLS AND EXPERIENCE

• Bachelors degree in finance or related field and minimum of two years in an analytical healthcare role required
• Knowledge of various reimbursement management areas such as patient billing, collections, cash posting, credit balance, resolution and other basic reimbursement functions
• Advanced analytical and problem solving skills
• Advanced knowledge of Excel
• Ability to communicate effectively both orally and in writing
• Strong interpersonal skills
• Strong organizational skills; attention to detail
• Ability to follow read and interpret insurance contracts

NONESSENTIAL SKILLS AND EXPERIENCE

• Experience with NextGen reporting
  

POSITION REPONSIBILITIES/ESSENTIAL

• Responsible for collecting, documenting, and analyzing reimbursement data
• Reports any reimbursement trends/delays to stakeholders (E.g., billing, denials, claim denials, pricing errors, payments, etc.)
• Prepares daily, weekly, monthly & quarterly and adhoc reports as needed
• Attends and participates in contract implementation meetings and teams to expand knowledge
• Assists management in generating reports for the purpose of acquiring new business and initiatives & pre-implementation proforma review
• Effectively utilizes various means for collections, including but not limited to phone, fax, mail and online methods
• Establishes effective relationships with other AHC departments; builds and maintains effective business partner relationships
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints and researches any disputes accordingly
• Frequently interacts with other finance staff, IT staff, billing department and management

Additional Duties and Responsibilities

• Other duties as requested or assigned

PCMH

All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.

Adherence to Compliance and Code of Conduct

All employees are required to comply with Adelante Healthcares written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelantes legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands and work environment characteristics 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.

Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The

employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.