Reimbursement Analyst- 813052

Academy of Managed Care Pharmacy • Alamogordo, NM, United States • $200k - $250k / year • 5m ago

Description

• Reviews payer EOBs but not limited to payment accuracy, patient liability, and appeal grievances.

• File appeals on underpayments.

• Forward appeal letters to scanning.

• Generate reports from the Managed Care module to identify issues but not limited to underpayments, total charge adjustments, missing calculations, and contract accuracy.

• Generate reports from the Managed Care module to assist management in identifying payer problem accounts.

• Create a monthly Medicaid HMO underpayment report for the CFO.

• Process incoming mail correspondence from payers within 3 business days.

• Follow up with the payer via phone and/or the website as needed.

• Enter detailed notes explaining account activity in the Patient Accounts system including expected payment calculation.

• Identify payer trends for resolution.

• Report payer trends to the Director and/or Assistant Director of Patient Financial Services.

• Assist the Reimbursement Specialist when needed.

• Respond to patient inquiries within 2 business days.

• Respond to interdepartmental inquiries within 2 business days.

• Respond to payer requests within 2 business days.

• Respond to emails within 2 business days.

• Maintain courtesy and respect at all times when working with internal and external customers.

Requirements

Education

Required:

High School

Licenses & Certifications

Preferred:

C-Heartsaver

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