Reimbursement Analyst

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary

Performs a variety of operational and financial analyses and reporting in order to maximize the collection of all billable charges. Employees work independently under the direction of an administrative superior and may serve as a project team coordinator or leader, working with staff from various levels of operation to resolve a particular issue. Employees work closely with clinical managers and staff to improve revenue flow.

Responsibilities

• Assesses accuracy of billing and conducts reimbursement audits. Recommends, and assists in implementing corrective actions resulting from reviews.
• Assists in designing specific procedures and systems changes. Coordinates with external organizations (including drug manufacturers and insurance carriers) on projects and issues to maximize reimbursement.
• Educates physicians and other clinic and administrative staff on concepts, issues and processes related to reimbursement. Prepares communications and training materials. Drafts technical documentation such as user guides for reimbursement systems and procedures.
• Monitors and analyzes a variety of data from internal and external sources to identify trends in reimbursement denials. Develops and execute reports which aid in analysis of financial data to determine root causes of problems. Charts and tracks revenue-related changes (e.g., charges, receipts, third party sponsorship, collection rates) over time.
• Prepares analyses of department fee schedules and makes recommendations for changes, considering new or changed CPT codes and other relevant information. Produces impact projections to assess the viability of any proposed changes to fee structures.
• Prepares appeals of third party decisions. Conducts background research collects data assembles documentation and follows up with agency to obtain decisions. Serves as liaison and manages records and files of such appeals. Directs mass claim refiles,
• Recommends changes to processes and other revenue structures. Recommends additional opportunities for increased revenue based on analyses.
• Serves on cross-departmental project teams to design, plan and implement changes in the operational processes and programming to enhance current processes and develop more efficient processes. Serves as special projects coordinator in systematic problem resolution.
  
  

Other Information

Other information:

Education Requirements

• Bachelor’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
  
  

Licensure/Certification Requirements

• No licensure or certification required.
  
  

Professional Experience Requirements

• If a Bachelor's degree: No experience required.
• If an Associate's degree: Four (4) years of experience in business analysis and planning, accounting, finance, health care administration or data base management/analysis.
• If a High School diploma or GED: Eight (8) years of experience in business analysis and planning, accounting, finance, health care administration or data base management/analysis.
  
  

Knowledge/Skills/and Abilities Requirements

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Pharm Revenue Integrity Progrm

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $23.01 - $33.07 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.