We are seeking a CO Reimbursement Analyst who will be responsible for monitoring third party professional fee contractual allowances, analyzing reimbursement variances and making recommendations to the Assistant Director, CPA Operations regarding payment discrepancies.
Specific Duties & Responsibilities
Procedural Knowledge
- Creates and maintains variance identification systems including loading and maintaining third party fee schedules and payer profiles.
- Monitors and tracks contract reimbursement performance and reports terms of concern negatively impacting payments to Director of Third Party and departments affected.
- Maintains a thorough knowledge of contract reimbursement requirements, invoice processing, payment posting procedures, and insurance carrier billing and payment policies.
- Participates in meetings with Third party payers and departments to recoup underpayments and resolve escalated claim issues. Discusses ongoing trends and issues regarding the administration of managed care contracts, payment irregularities and reimbursement trends.
- Manages the collections of Single Case Agreements and maintains accounts receivable balances within departmental standards.
- Manages the collections of Out-of-State Medical Assistance claims and maintains accounts receivable balances within departmental standards.
- On a daily basis, provide professional consultation and assistance regarding industry standards, regulations, and payment operations, to department staff, Production Unit Managers, Associate Directors, Directors, and Senior Directors within the SOM and JHBP to improve receivable collectability and staff efficiencies.
- Develop and maintain liaisons with Third Party Payer representatives through face-to-face meetings, telephone interactions and written correspondence to enhance contractual compliance, payment accuracy and understanding of carrier system workflows and policies.
Technical Knowledge
- Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
- Utilize internal and external resources including EPIC, electronic medical records, payer websites, and other resources to facilitate efficient operations, issue resolution, and education.
- Excellent communication and customer service skills with the ability to work well under pressure and provide guidance on industry standards, regulations, and payment operations for patients, physicians, administrative staff, team members and payers in a high-volume medical services environment.
- Possess detailed knowledge of medical policies, medical terminology, and National Correct Coding standards including CPT codes, diagnosis codes and all modifiers that affect billing and the revenue cycle operations.
- Strong working knowledge of standard invoice processing/payment posting procedures and generally recognized PBS billing applications and policies.
- Knowledge of managed care contracts, reimbursement policies and JHU variance monitoring systems as applicable.
Professional & Personal Development
- Participates in ongoing educational activities.
- Assists in the training of staff.
- Keeps current of industry changes by reading assigned material on work-related topics.
- Completes three days of training annually.
Service Excellence
- Must adhere to Service Excellence Standards.
- Customer Relations.
- Self-Management.
- Teamwork.
- Communications.
- Ownership/Accountability.
- Continuous Performance Improvement.
Special Knowledge, Skills, & Abilities
- Strong analytical skills.
- Advance level in Microsoft Excel.
- Requires excellent independent research skills.
- Requires analytical and decision-making skills to solve complex problems.
- Able to operate basic office equipment, e.g., photocopier, fax machine, scanner, PC, telephone, etc.
- Technical qualifications or specialized certifications: n/a.
Specific Physical Requirements
- Able to sit in a normal seated position for extended periods of time.
- Able to reach by extending hand(s) or arm(s) in any direction.
- Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard.
- Able to communicate using the spoken and written word.
- Able to see within normal parameters and to hear within normal range.
- Able to move about.
- Able to lift minimum weight, 10 lbs.
Minimum Qualifications
- Bachelor’s Degree in related field required.
- Five years’ experience in professional fee billing and collections with a focus on third party contract reimbursement and management required.
- Additional education may substitute for required experience and additional related experience may substitute for required education, to the extent permitted by the JHU equivalency formula.
Classified Title: Reimbursement Analyst
Job Posting Title (Working Title): CO Reimbursement Analyst
Role/Level/Range: ATP/04/PD
Starting Salary Range: $62,900 - $110,100 Annually ($72,400 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F 8:30AM-5PM
Exempt Status: Exempt
Location: Hybrid/JH at Middle River
Department name: SOM Admin CPA Third Party Reimbursements
Personnel area: School of Medicine
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