Remote - Payment Validation Analyst

Mosaic Life Care; Georgia; Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Concierge services

Employee lounge

Wellness programs

Free parking

On-site health clinic

Virtual health clinic

Job summary

Mosaic Life Care in Georgia seeks a Payment Validation Analyst to ensure accurate payor receipts and resolve underpayments. You will analyze contract discrepancies, rebill projects, and act as a payer reimbursement expert across coding, charging, and contract changes.

The role requires a Bachelor's degree and at least five years in hospital financial operations, with Epic/CDM knowledge. Travel to off-site locations may be required. A remote option is available for eligible states.

Qualifications

• Bachelor's degree is required.
• Minimum five years of health care experience in hospital financial operations.
• Extensive knowledge of reimbursement, coding, and charge master development.
• In-depth knowledge of CPT/HCPCS/ICD-10 and Medicare APC reimbursement.
• Epic Contracts Module certification is preferred upon hire.

Responsibilities

• Analyze contractual underpayments and resolve daily encounters in Epic WQs.
• Identify root causes for price/contract discrepancies and implement corrections.
• Lead rebill projects to recoup underpayments.
• Serve as subject matter expert on payer reimbursements and contracts.
• Research non-covered/denied charges and assist with appeals.
• Identify coding, charging, and billing issues and educate staff.
• Prepare monthly measurement reports using Epic for findings and recommendations needing Director approval.
• Create and maintain contracts in Epic.
• Assist startup for new programs and identify reimbursable services.
• Research CPT/HCPCS/ICD-10 issues referred by PFS/Coding/Revenue Integrity.
• Coordinate routine projects and plan steps.
• Apply flowchart techniques with minimal direction.
• Other duties as assigned.

Skills

Data entry

Communication

Typing

Phone etiquette

Problem solving

Education

Bachelor's Degree

High School Diploma

Job description

The Payment Validation Analyst works under the supervision of the Director of Revenue Integrity. Responsible for ensuring accurate payment is received from payors, including line level payment validation where appropriate.

Responsibilities

Remote States: Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. Remote work will not be permitted from any other state at this time.

• Responsible for analyzing contractual underpayments. Identify and resolve daily encounters holding in Epic WQs for contractual underpayments. Identify root cause and work on corrective action implementation.
• Responsible for resolving encounters in Epic WQ for price/contract discrepancy. Identify root cause and work with CDM Analyst/Revenue Integrity Analyst to implement fee schedule correction, and/or identify root cause causing the discrepancy.
• Works on rebill projects focused on recoupment of underpayments.
• Subject matter expert regarding payer reimbursements and contracts. Be informed of changes to payer reimbursement and work with CDM Analyst and/or Revenue Integrity Analysts to implement changes, if and as needed.
• Research non-covered and/ or denied charges to identify root causes. Works with the Revenue Integrity Manager to assist with appeals.
• Identifies Coding, Charging, and/ or Billing issues/ patterns that are resulting in inaccurate payment and works with/ educates the appropriate staff to resolve them. Monitors and tracks accounts that have been identified for re-billing to ensure proper payment is ultimately received.
• Utilize Epic reports to prepare monthly measurement reports regarding any/ all findings, follow-up actions taken, and any recommendations that need DIRECTOR or above approval.
• Creates and maintains contracts in Epic.
• Assists with the start-up process for new programs. Helps to identify services that are reimbursable but are not being coded or charged for.
• Research and resolves CPT code, revenue code and other charge master related issues referred by the Patient Financial Services, Coding, or Revenue Integrity departments.
• Coordinates routine individual projects by planning and organizing project steps.
• Utilizes logical sequential steps and understands flowchart techniques with minimal direction when working on projects.
• Other duties as assigned

Education

• Bachelor's Degree - Required
• H.S. Diploma - Required

Work Experience

• 5 Years - Health care experience. Minimum five years' experience and knowledge of hospital financial operations including reimbursement, Medical Billing, Charge Master Development and Maintenance, Medical Records/Coding and Charge Audit experience. - Required
• 5 Years - Broad based knowledge of hospital financial operations including reimbursement, coding and charge master development and maintenance. - Required
• 5 Years - In-depth knowledge of CPTs, HCPCs and ICD-10 medical coding, and related APC Medicare reimbursement. - Required

Licenses and Certifications

• Epic Certifications - Epic Contracts Module Certification - Preferred Upon Hire

Travel Requirements

• Travel to off-site locations may be required. - Required

Qualifications

Skills and Abilities

Essential Technical/Motor Skills

• Input data, type, manipulate calculator and small business equipment, speak clearly and professionally, answer telephone, copying.

Interpersonal Skills

• Oral and written communication skills with staff, leadership, physicians and consultants on an individual basis as well as interaction on teams.

Essential Physical Requirements

• Lifting, moving, reaching, bending, stooping, standing, walking, typing, operating small business equipment.

Essential Mental Abilities

• Analyze, synthesize, evaluate, comprehend, explain, understand, forecast, interpret, manipulate numbers, interpret data, calculate, organize, plan, small and large group presentations.

Essential Sensory Requirements

• Eyesight, hearing.

Exposure to Hazards

• Electrical output of personal computer, eye/neck strain.

Other Skills and Abilities

• Must be a highly energetic, motivated self-started.
• Must have the ability to determine areas of concern.
• Accuracy important 95% of the time.
• Confidentiality important 100% of the time.

Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care.

Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.