Revenue and Reimbursement - Reimbursement Analyst - 40hrs

Connecticut Children's; Connecticut; On-site; USD 60,000 - 90,000; Full time

Job summary

Connecticut Children’s is seeking a Reimbursement Analyst to analyze incoming payment information and contract terms to ensure timely payment according to agreements. The role supports EPIC HB processes and collaborates with payer representatives, physicians, and patients while upholding CCMC policies.

The candidate should have 3–5 years in healthcare revenue cycle or finance and an Associates degree or equivalent; a Bachelor’s is preferred.

Qualifications

• Associates degree or equivalent experience required.
• 3–5 years of healthcare revenue cycle or finance experience.
• Bachelor’s degree preferred.

Responsibilities

• Reviews payer payments; researches and resolves hospital payment discrepancies and ensures contractual rates received by way of working Epic work queues.
• Reviews payer policies as communicated.
• Regularly monitors underpaid hospital claims to ensure full resolution.
• Coordinates and leads monthly payer calls including agenda and spreadsheets.
• Identifies HB contract proration issues and documents accordingly.
• Trends proration issues and quantifies for prioritization.
• Manages all HB Payer Variance W/Qs within EPIC.
• Participates in activities to enhance billing and collection efforts related to third party reimbursements.
• Determines whether remaining claim balance should be written off or referred to higher level of management for write-off decision.
• Assists with ad hoc reimbursement requests by utilizing RAD reporting, contracts and fee schedules.
• Other duties as assigned by management.
• Demonstrates cultural sensitivity in all interactions with patients/families and co-workers.
• Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CCMC STANDARDS.

Skills

Analytical skills

Interpersonal communication

Problem-solving

Attention to detail

Organizational skills

Education

Associate degree

Bachelor's degree preferred

Tools

EPIC HB Reimbursement Contracts

Excel

MS Word

Job description

Job Description

The Reimbursement Analyst is responsible for analyzing incoming payment information and other communications (from payers, physicians, and patients) along with applicable contract terms, reimbursement schedules, government regulations and internal policies. The Analyst ensures that Connecticut Children’s Medical Center (CCMC) is paid timely and according to contracted terms for the services rendered. Ensures that all actions taken are consistent with a broad variety of government regulations, contractual terms and internal policies and procedures. Works under general supervision following established protocols and procedures. The Analyst maintains confidentiality of all information. This position reports to the Senior Regional Contracting Manager of the Revenue & Reimbursement Department.

Responsibilities

• Reviews payer payments; researches and resolves hospital payment discrepancies and ensures contractual rates received by way of working Epic work queues.
• Reviews payer policies as communicated.
• Regularly monitors underpaid hospital claims to ensure that they are brought to full resolution.
• Coordinates and leads monthly payer calls including appropriate staff ensuring agenda and spreadsheets are shared in a timely manner.
• Identifies HB contract proration issues and documents accordingly.
• Trends proration issues and quantifies for prioritization.
• Manages all HB Payer Variance W/Qs within EPIC.
• Participates in a variety of activities to enhance billing and collection efforts related to third party reimbursements.
• Determines whether or not remaining claim balance should be written off or referred to higher level of management for write-off decision.
• Assists with ad hoc reimbursement requests by utilizing RAD reporting, contracts and fee schedules.
• Other duties as assigned by management.
• Demonstrates cultural sensitivity in all interactions with patients/families and co-workers.
• Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CCMC STANDARDS.

Qualifications

Education and Experience Required

• Education Required: Associates degree required from accredited college or university or equivalent experience.
• Experience Required: Three to Five years of healthcare revenue cycle or finance experience.

Education and Experience Preferred

• Preferred education & experience. Bachelor’s preferred or equivalent experience

License and/or Certification

• N/A

Knowledge, Skills, and Abilities:

Knowledge of:

• ICD-10, CPT, HCPC, Medical Terminology.
• MS Word and Excel.
• Insurance regulations and reimbursement policies.
• EPIC HB Reimbursement Contracts.

Skilled at:

• Must possess excellent interpersonal, communication, problem-solving, and organizational skills.
• Detail oriented.
• Excellent analytical skills.

Ability to:

• Analyze data, identify errors & resolve problems in a timely manner.

About Us

Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children’s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.

At Connecticut Children’s, treating children isn’t just our job – it’s our passion. As a leading children’s health system experiencing steady growth, we’re excited to expand our team with exceptional team members who share our vision of transforming children’s health and well-being as one team.