Revenue Analyst -Hospital Billing- Remote
- Job ID: 41113
- Entity: Lifespan Corporation
- Location Name: Corporate Headquarters
- City, State: Providence, RI
- Work Type: FULL TIME
- Hours Per Week: 40.00
- Shift: Day
- Posted Date: 4/3/2023
Summary:
Under the general direction of the Director Contracting Analytics and Modeling perform all duties necessary to properly identify and process recovery of revenue for Contract Management and Managed Care denials for Lifespan and its Rhode Island affiliates. Take appropriate steps to identify review and reduce Managed Care denials of coverage. Audit Managed Care actual payments against contracted payments and initiate adjustment process to recover any identified underpayments.
Responsibilities:
In conjunction with the Lifespan Patient Financial Services Department identify and coordinate all efforts to recover Managed Care underpayments. Assist to implement and monitor compliance of Managed Care contract reimbursement. Report non-compliance and payer issues to the Director of Contracting.
Assist the Director of Contracting in compiling any necessary statistics needed for contract management and follow-up activities.
Ensures timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts. Meets with Managed Care payers Contracting and PFS follow-up staff as necessary to resolve disputes related to accounts receivable and to discuss changes in contracts. Identifies and initiates corrective measures and rebilling of improper denials and underpayments by Managed Care contractors.
Process all necessary online adjustments or changes as needed such as adding/deleting insurance information insurance priority changes balance transfers demographic changes contractual allowances any other routine patient accounting adjustment not requiring supervisory approval.
Continually evaluates work flow and identify opportunities to improve process and full and complete payment for hospital services.
Analyze financial and contractual data used in determining reimbursement compliance. Compile review adjust and monitor any variances. Ensure accuracy efficiency and integrity of all information systems pertaining to Managed Care denials and reimbursement.
Participate in staff meetings councils quality improvement teams and other such meetings and committees as required.
Develop and maintain working relationship with Lifespan affiliate departments as needed to ensure full data exchange.
Troubleshoot existing and/or potential problems in the claims processing process and contract management modeling system recommending changes as appropriate.
Maintain quality assurance safety environmental and infection control in accordance with established policies procedures and objectives of the system and affiliates.
Perform other related duties as required.
Other information:
BASIC KNOWLEDGE
Bachelor�s Degree in health services administration finance or related field or the equivalent experience.
Comprehensive knowledge of patient accounting activities in an automated networked multiple hospital environment.
Detailed knowledge of reimbursement schemes for predominant payers.
Detailed knowledge of regulatory requirements.
EXPERIENCE:
Three years� experience in patient accounting.
Ability to make sound interpretation of Managed Care contract language.
Ability to perform financial analysis.
INDEPENDENT ACTION:
Functions independently within Lifespan and Department policies.
SUPERVISORY RESPONSIBILITY:
None.
Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.
Location: Corporate Headquarters USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union
