Payor Reimbursement Analyst

10100 Children's Hospital; United States; On-site; USD 87,000 - 145,000; Full time

Job summary

Children’s National Hospital in Silver Spring, MD is seeking a Payor Reimbursement Analyst to support financial sustainability through Medicaid and Commercial payor research. You will track denials, assist with appeals, and collaborate with Revenue Cycle, Access, Clinics, Managed Care and Legal.

Required BSN; 5+ years of experience with 3 years in Utilization Review. Strong communication, business writing and MS Office skills are essential for success in this role.

Qualifications

• BSN required; Master’s degree preferred for progression.
• At least 5 years of work experience with 3 years in Utilization Review.
• Strong verbal and written communication skills; proficient in MS Office.

Responsibilities

• Authorize and deny decisions with timely, accurate review and clear direction.
• Track, trend and analyze authorization issues and denials by payor.
• Collaborate with CRM, Revenue Cycle, and hospital staff to optimize reimbursement.
• Educate staff on authorization processes and denial patterns.

Skills

Utilization Review

Verbal communication

Business writing

Education

BSN

Master's degree (preferred)

Tools

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

Job description

12211 Plum Orchard Drive Silver Spring, MD 20904 Kids Are Our Everything. Department 10119 Eligibility and Financial Clearance Pay Range $87,172.80 - $145,267.20

The Payor Reimbursement Analyst will support the financial sustainability of the organization through timely , accurate and thorough research of reimbursement issues related to Medicaid and Commercial payors. Responsible to track, trend and reconcile data and report to the Revenue Cycle. Develop and maintain collaborative relationships with payors, Access, Clinics, Managed Care, Business Operations, Leadership and Legal departments.

• Minimum Education BSN (Required) Master's Degree (Preferred)
• Minimum Work Experience 5 years Experience with 3 years of Utilization Review. (Required)
• Required Skills/Knowledge Ability to critically think and apply logic and reasoning to dynamically changing healthcare environment. Requires superior verbal communication skills and service excellence approach with internal and external stakeholders. Must have strong business writing skills. Proficient at keyboarding and facile with Microsoft Office Excel, Access and Power Point.

Functional Accountabilities

Authorizations & Denials Provide timely , comprehensive and accurate review of authorizations/denials to determine appropriate course of action. Provide clear direction to others to resolve authorization/denial issues. Provide timely appeals which are based on standardized criteria (Interqual and MCG) and follow appropriate escalation processes. Monitor payor response to appeals to ensure timely claim payment or write-off. Function as a subject matter expert for CRM, Revenue Cycle and the organization.

Data Management

Tracks, trends and analyzes all authorization issues and denials by payor utilizing relevant software. Report data on a weekly, monthly , quarterly or yearly basis as requested to report out to Revenue Cycle. Propose process improvements for a variety of stakeholders based on data analysis to mitigate future denials.

Communication/Collaboration

Communicate and collaborate with internal and external partners to optimize reimbursement. Actively participate in payor meetings to contribute to Children's discussion of Authorization and Denials data and trends. Develops cogent, comprehensive appeals utilizing standardized criteria or evidence.

Education

Contribute to the education of CRM, Medical and other hospital staff about authorization and denials. Based on authorization and denial patterns, develops and implements an educational plan for various staff roles.

The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.