Reimbursement Analyst II/III

About the role

This position is the primary representative for Physician, Ancillary and Facility reimbursement analysis. The incumbent's analyses include but is not limited to, contracting strategies; calculation and testing of provider rates; implementation oversight for all regions and monitoring of provider reimbursement.

Responsibilities

• Supports reimbursement strategy and analysis through various duties included running data queries for analysis and evaluation of current to proposed reimbursement rates.
• Works with Provider Contracting on reimbursement implementations to ensure provider contracts are executed timely, accurately, and in compliance with all internal policies and procedures.
• Supports all internal and external audits related to physician, ancillary and facility reimbursements, including charge creep, cost plus, outpatient formula, and capital audits, according to provisions of provider contracts.
• Communicate results of findings and initiates payment recovery / reimbursement.
• Calculates and implements rate adjustments and enhancements as necessary.
• Researches and manages resolution of provider payment inquiries, disputes and issues.
• Participates and supports all Compliance related Audits and requests including following all process documentation and updated as needed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

Requirements

• Bachelor's Degree in related field required. In lieu of degree, six years of relevant experience required.
• Strong analytic skills, including root cause analysis, along with capacity to identify business objectives and associated risks.
• Ability to complete thorough research, exercise good judgment and work independently.
• Good, demonstrated interpersonal relations skills.
• Excellent written and oral communications skills required.
• Comprehensive working knowledge of software programs: Intermediate level Excel, Word, Power Point, Microsoft Access, SAS, Cognos, or other data extraction tool; and general knowledge of MS Outlook and ability to access internet web sites and databases.

Qualifications

• Three years of business experience including analysis, problem solving, and data extraction/modeling required.
• Previous experience in health-related field preferred.
• Demonstrated experience in pricing to include price calculation for otherwise non-sourced pricing structures.
• Strong familiarity with Healthcare Reimbursement Methodologies and their application.
• Demonstrated ability to interact effectively with providers and internal business partners.

Level III

• Seven (7) years of business experience including analysis, problem solving, and data extraction/modeling required.
• Previous experience in health-related field preferred.
• Experience having identified strategic opportunities through data and driving it toward measurable result.
• Demonstrated ability to interact effectively with external business partners, TPA’s and Provider representatives.
• Demonstrated ability to make effective presentations to front line internal/external management or provider groups.

Physical Requirements

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.