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Reimbursement Analyst Managed Care Remote

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About the position

Responsibilities

  • Ensure timely and accurate loading of providers with Managed Care contracted payers.
  • Evaluate professional fee contractual adjustments for accuracy according to payer contracts and federally mandated guidelines.
  • Support payment variance identification for the Physician Enterprise (PE).
  • Collaborate with practice office operations staff, Managed Care contracting, Credentialing and Enrollment, and billing support teams to identify and recommend corrective actions on payment variances.
  • Submit delegated and nondelegated credentialing reports after completion of credentialing and enrollment tasks.
  • Confirm accuracy and timeliness of provider information entered into payer systems and directories.
  • Enter effective date and provider number information into Athena/Epic and MSOW Network Management to release held claims and update status reports.
  • Review and resolve claim denials related to credentialing and enrollment status of providers.
  • Identify payment variances for professional fee commercial contracts and government payers, reviewing reports to determine true variances based on reimbursement guidelines.
  • Liaise with payers to request provider profile updates and negotiate discounts as directed by management.
  • Maintain knowledge of current rules and regulations of Commercial and Government programs.
  • Review contractual adjustments to determine causes and categorize variance types for management review.
  • Serve as a subject matter resource for payment variance identification and education.
  • Meet with PE and MC to update provider load, variance projects, and specific payer issues.
  • Analyze data to provide insights on payer reimbursement trends and load accuracy for provider profiles.
  • Coordinate with billing support teams on identified payment variances and credentialing denials.
  • Complete special projects as assigned by the reimbursement manager.

Requirements

  • High school or equivalent degree.
  • Minimum of 3 years of relevant experience in healthcare reimbursement including Commercial and Government payers.

Nice-to-haves

  • Bachelor's Degree in healthcare, business administration or related field.
  • System experience in identifying payment variances (Athena/Epic).
  • Experience in claim denial follow-up with payers.

Benefits

  • Benefits from Day One
  • Career Development
  • Whole Person Wellbeing Resources
  • Mental Health Resources and Support
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