Reimbursement Analyst Resume Sample
Yasmin Tremblay
849 Justina Forks,
Dallas,
TX
+1 (555) 211 6635
Work Experience
Senior Reimbursement Analyst
05/2017
-
PRESENT
Phoenix, AZ
- Compile data for annual and periodic fee schedule analysis
- Compiles daily/monthly reports that affect multiple departments or areas related to reimbursement issues
- Update and maintain provider fees/fee schedules in computer system (Excel and IDX)
- Prepare, publish, and distribute fee schedules (paper)
- Daily review of the Missing Fee WQ in Epic. Work with the Business Groups to resolve any missing fees or billing errors in the WQ resulting in a blank or zero fee in the amount field
- Develop, maintain, and update Excel spreadsheets with commercial and government carrier allowable information. Format data into flat files for import into the Epic system
- Perform research and analysis of managed care contracts as directed by Director of Clinical Data Quality
- Perform annual impact analysis of Medicare and Medicaid annual rate changes
Reimbursement Analyst
04/2011
-
01/2017
Phoenix, AZ
- Perform annual impact analysis of fee schedule changes
- Compile department, division, billing area, and location specific analyses of charges and payments by carrier to assist Accounting with determining reasonable collection rates as necessary for the budget process
- Review annual additions, deletions and updates on procedure and diagnosis codes and coordinate with IS to update respective edits and dictionaries as needed. Communicate potential impact of major changes to Business Group Managers to incorporate needed adjustments in annual budget calculations
- Develop, maintain, and update charge capture forms (including superbills) as needed. Review EpiCare Templates used by Clinics and Physicians for accuracy and coding changes
- Assist providers, clinic personnel, and billing staff with reimbursement information and carrier specific billing guidelines
- Remain current on all coding and reimbursement issues
- Assist Education department with research and analysis for coding related projects
Value Based Reimbursement Analyst
09/2006
-
10/2010
New York, NY
- Assist Special Projects Department with managed care related inquiries and projects as necessary
- Assist with compiling initial book order for CPT, HCPCS, ICD-10 and Specialty books for all UFJP annually. Prepare excel spreadsheets to be used for purchase order requests, receiving signatures, and accounting reconciliation. Facilitate delivery/pick-up of books from within the Reimbursement department after books are delivered, inventoried and reconciled to the original order
- Abstract data from EHR for annual Medicare GPRO measures. Prepare data for upload into the CMS web-interface system
- Conduct periodic GPRO measure audits throughout the year to ensure compliance with documenting quality measures. Provide feedback to physicians and clinics with results and areas for improvement
- Analyze results from GPRO submission and provide summary feedback to departments for quality improvement opportunities
- Assist Manager of Reimbursement and Quality Improvement and Director of Clinical Data Quality with research and analysis for special reimbursement projects
- Review Research Study Initiation Request Forms (RSIRFs) for proper coding and pricing. Communicate with research coordinator or other appropriate individuals to resolve conflicts in the information prior to submitting RSIRF to Manager of Reimbursement and Quality Improvement for final signature
Education
University of North Carolina at Asheville
2001 - 2005
Bachelor's Degree in Accounting
Professional Skills
- Excellent organization and time management skills and flexibility to handle changing priorities
- Possess excellent analytical and problem solving skills, including experience with Crystal Reports or other querying tools
- Strong interpersonal skills with the ability to effectively communicate with others
- Excellent communication skills both on the telephone and in writing
- Strong people relations skills and the ability to manage and persuade others toward common objectives and help bring win/win solutions to problems
- Experience: 3-5 years of experience in reimbursement or experience in healthcare environment
- Proven organizational skills and successful process improvement initiatives
How to write Reimbursement Analyst Resume
Reimbursement Analyst role is responsible for excel, advanced, microsoft, software, access, interpersonal, analysis, computer, health, analytical.
To write great resume for reimbursement analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Reimbursement Analyst Resume
The section contact information is important in your reimbursement analyst resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Reimbursement Analyst Resume
The section work experience is an essential part of your reimbursement analyst resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous reimbursement analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular reimbursement analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Reimbursement Analyst resume experience can include:
- Conduct weekly audits on Research Guarantor records in Epic to ensure registration errors have not corrupted the accuracy of the data. Make corrections and provide feedback as needed
- Conduct weekly audits on Personal/Family accounts to ensure research coverage has not been incorrectly assigned. Make corrections and move transactions as appropriate
- Monitor accounts for patients being associated to a Research Study but no Research Coverage added to their Guarantor accounts. Make corrections and provide feedback as appropriate
- Assist with preparation of Medicare and Medicaid cost reports and other regulatory filings, and the related work papers in accordance with all applicable regulations and Providence policies under the guidance of the Manager
- Strong analytic skills and extensive experience with spreadsheet software, i.e, Excel, SQL
- Previous experience with Medicare and Medicaid regulations related to Skilled Nursing Facilities, Home Health Agencies, etc
Education on a Reimbursement Analyst Resume
Make sure to make education a priority on your reimbursement analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your reimbursement analyst experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Reimbursement Analyst Resume
When listing skills on your reimbursement analyst resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical reimbursement analyst skills:
- Typing skills and 10-key required
- Experience as hospital Reimbursement staff or auditing experiences with Fiscal Intermediary required
- · Ability to communicate effectively both written and oral
- Prior experience with Crowe RCA
- Cost accounting, Medicaid Experience, Relationship management, Medical claims experience
- Coding, Reimbursement and/or Billing experience is highly desirable
List of Typical Experience For a Reimbursement Analyst Resume
1
Experience For Senior Reimbursement Analyst Resume
- Working knowledge of personal computers as well as information systems capabilities, procedures and practices with advanced Excel skills
- Relevant experience (i.e., auditing, consulting, accounting, reimbursement systems in healthcare)
- Good understanding of the application, development and value of health economic modelling
- Previous experience providing reviewing reimbursement and appeals to payers
- Related experience in a healthcare setting required
- Working knowledge of professional, ancillary, and hospital reimbursement methodologies with working knowledge of standard health care code sets
- Running A/R Reports, customer lists, and reviewing revenue reports for potential issues
- Leads modeling and analyzing cash forecasts and developing cash management reports
- Research and reconcile missing payments, ensure monies are posted correctly, and researching reconciling issues
2
Experience For Provider Reimbursement Analyst Resume
- Organizes and records various incoming statistical data for the department or functional area and prepares summary worksheets for outgoing reports
- Develop and maintain provider fee schedules/internal benchmarks using knowledge of standard external benchmarks and Florida Blue pricing strategies
- Analyzes and gathers data as a resource to system CFO’s and trains department associates on writing and running reports
- Knowledge of medical billing systems and clearing houses with special emphasis on home health, hospice, infusion and private duty
- Work independently while maintaining quality work and exercising attention to detail
- Proficiency with CPT-4 procedural coding, HCPCS and ICD-10 diagnosis coding
3
Experience For Value Based Reimbursement Analyst Resume
- Track record of developing and delivering reimbursement/market access strategy
- Works with billing offices on revenue issues and training issues as needed
- Create training and deliver education programs to sales force, physicians, insurers, public payors, medical directors, billing personnel, and pharmacists
- Ensure accuracy of capitation payments by reviewing and investigating capitation data
- CPC or other outpatient, physician-based coding credential required within 6 months (or 2 months following completion of internal CPC prep classes)
- Prepares reports and supporting schedules
- Assists with the user support activities for the accounting systems
4
Experience For Senior Reimbursement Analyst / Umms Resume
- Researches existing data sources to determine their functionality and appropriate use
- Develops and maintains revenue modeling systems
- Estimates Medicare, Medi-Cal, and third party payer contractuals and bad debt allowances; prepares journal entries for recording allowances and reserves
- Member of contract negotiation team for supplemental funding streams
- Reconciles accounts receivable subsidiary ledgers/systems to the general ledger, including, but not limited to, government patient admission logs
- Functions as a back-up to members of the accounts receivable follow-up team within the Physician Billing Department
- Evaluate current business practices, looking for ways to improve productivity, reduce costs, and make the best use of the business's resources
5
Experience For Reimbursement Analyst, Senior Resume
- Reviews denials to identify trends and opportunities for rule building within the claims scrubber and the practice management system
- Perform analytical review of data using Excel and SQL
- Assist with cash posting functions as needed
- Communicate verbally I and in writing inside and outside the company
- Participates in an ongoing coordination and resolution of revenue cycle issues as they arise
6
Experience For Underpayment Reimbursement Analyst Resume
- Proficient understanding of EPIC Fee Schedule logic
- Proficient understanding of EPIC RSH records and how they affect registration and charge flow
- Deliver relevant data and tools to meet country HTA/reimbursement/funding and access needs within region
- Identify and pursue opportunities to obtain reimbursement and provide support in HTAs and funding submissions with particular focus to the designated countries
- Support local countries with selected reimbursement /funding/ HTA submissions
- Develop rate-setting models based on cost report and other related information and update those models on an as needed basis
- Represent the company during cost report audits as necessary
7
Experience For ESC Ops NAM Expense Reimbursement Analyst Resume
- Assist in identifying areas that need to be reworked/addressed
- Create and maintain pricing matrices and payer setups associated as directed
- Provides reimbursement-related guidance to marketing, sales, regulatory, clinical and business leaders
- Resolve provider reimbursement issues including capitation and claim refunds and stop payments
- Work collaboratively with the accounting unit to place stop payments
- Work in a team approach as well as being independent and self directed with daily work flow
- Proficiency in Microsoft Office Suite including Word, spreadsheet applications (Excel), Lotus Suite, graphics and cost report software
8
Experience For Reimbursement Analyst, Assoc Resume
- Communicate and collaborate with colleagues from varying hospital departments as well as hospital external customers
- Assist with the preparation and analysis of proposed audit adjustment impacts and additional documentation as required by the MAC or regulatory agency
- Prepare monthly workbooks and resultant journal entries to record third party settlements, and provider taxes payable and supplemental payments receivable
- Perform basic financial analysis and provide technical support for Reimbursement leadership, as requested
- Continuously monitor workload and methodologies used and communicate workload status to manager and leadership and other team members to achieve results
- Ensure that all assigned statutory filings are timely and accurate
- Prepare Medicare and Medicaid cost reports and other regulatory filings, and the related work papers in accordance with all applicable regulations and Providence policies under the guidance of the Manager
- Prepare monthly workbooks and resultant journal entries to record third party settlements, and provider taxes payable and supplemental payments receivable. Assist the Manger/Director in validating the workbooks stay current with regulatory changes
- Related work experience or equivalent combination of transferrable experience and education
9
Experience For Contracting & Reimbursement Analyst Resume
- Experience: At least 3 year(s)
- Prepares and validates contracts between the Hospital, DHCS and Provider Plans required under the Managed Medi-Cal supplemental rate range and SPD programs
- Experience in healthcare reimbursement
- Strong knowledge of Hospital and Medicare reimbursement methodologies
- Perform financial analysis and provide technical support for Reimbursement leadership
10
Experience For Reimbursement Analyst Intermediate Resume
- Continuously monitor workload and methodologies used to achieve results, making recommendations to improve efficiency and/or achieve cost savings whenever possible
- Prepare Medicare and Medicaid cost reports, specific cost report appeal issues and protested items, and the related work papers in accordance with all applicable regulations and Providence policies under the guidance of the Manager
- Ensures costs are allocated according to established procedures and revenue is optimized according to federal regulations
- Collects data, allocates/determines costs and prepares reports that maintain the company's reimbursement systems
- Oversees entries into computer files, runs required programs and analyzes and reconciles output to source documents
- Researches and corrects problems
List of Typical Skills For a Reimbursement Analyst Resume
1
Skills For Senior Reimbursement Analyst Resume
- Understanding of economic model development and cost-effective analysis
- Work experience in providing coding, coverage, and payment advice in a healthcare setting with an emphasis on cardiology
- Five years' healthcare experience specific to business office or patient accounting to develop an understanding of general healthcare revenue cycle processes
- · Ability to maintain effective working relationships with others
- Compiles, models, validates and analyzes data to understand current trends, facilitating well-informed decisions
2
Skills For Provider Reimbursement Analyst Resume
- Experience in physician third-party billing and accounts receivable
- Strong proficiency with Microsoft Office products; especially spreadsheet, word processing, data base management, and presentation software
- Preference for candidates with experience auditing insurance claims with a thorough knowledge of
- Experience managing change and or radical redesign of a major system or service preferably in an academic health care environment is necessary
- Compile, model,validate and analyze data to understand current trends, facilitating well-informed decisions
3
Skills For Value Based Reimbursement Analyst Resume
- Experience with developing new databases with the ability to create and modify System Tables, Views, Stored Procedure and Functions
- Experience with Data Profiling and Data Segmentation
- Experience with Visual Studio, Visio, and Crystal Report, UltraEdit
- Experience with system and database migration
- Completes and submits all enrollments for revisions and revalidations related to all State Medicaid plans
- Three years healthcare reimbursement/finance experience
- Experience with third-party medical reimbursement methodologies
- · Five (5) years experience in home health agency, accounting, business office operation or Medicare cost reporting
4
Skills For Senior Reimbursement Analyst / Umms Resume
- Experience compiling and analyzing data
- Experience creating databases and working with databases
- Professional experience in health care reimbursement, public accounting or financial analysis
- Healthcare billing and collections experience
- Hospital reimbursement experience including the preparation of Medicare, Medical Assistance and Blue Cross cost reports
- Applicable experience in medical/healthcare reimbursement
- Experience with management information systems and medical software
- Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behavior, practices and decisions
5
Skills For Reimbursement Analyst, Senior Resume
- Understand and demonstrate the qualities identified in the firm’s Code of Conduct
- Maintain and/or enhance client service through work quality, work efficiency, and excellent client relations
- Models teamwork and cooperation, acts as an effective team member and actively contributes to team success
- Sitting, standing, repetitive motion, minor lifting
- Understanding of the complete revenue cycle management related to medical billing and reimbursement process
- Involvement in the analysis of a variety of consulting projects including development of templates, project meetings and sharing of end product with client
- · Advanced knowledge of hospital accounting and Medicare cost accounting fundamentals
- One or more of the following coding credentials: RHIA, CCS, CCS-P, CPC or CIRCC
6
Skills For Underpayment Reimbursement Analyst Resume
- Update and maintain current coding, coverage, payment information and tools that supports customer understanding and education
- · Knowledge of accounting, statistics and general business principles and practices
- Basic understanding of the various payment systems and healthcare reimbursement
- Download data needed from the financial and revenue reporting systems for the various filings prepared by the team
- Use access, excel and other programs to obtain and organize the data in the format needed. Provide support to the team as needed in preparing this data
- Maintain detailed audit trails so that all necessary supporting documentation is available to be included with the filings
7
Skills For ESC Ops NAM Expense Reimbursement Analyst Resume
- Acts as a contact within Revenue Cycle Management Operations (Billing) for payer information, payer communication and issue identification
- Conducts comprehensive audits of revenue areas subject to basic code-based reimbursement including
- Extensive knowledge of accounting, financial management, and Medicare and Medicaid reimbursement principles, methods and procedures
- Knowledge of Medicare, Medi-cal, and private insurance billing
- Knowledge of healthcare operations throughout the Revenue Cycle. Knowledge of payment posting practices
- Problem-solving abilities and a high attention to detail
- Serve as point of contact for incoming questions from Regional Economic Managers, sales team members and external customers via the RS mailbox
8
Skills For Reimbursement Analyst, Assoc Resume
- Contribute to solutions to reimbursement coding, payment and coverage challenges for commercialized products
- Consistently meet deadlines, while maintaining high quality work
- Models the DHG values, people like working with this person, delivers work timely and accurately, supports the team’s efforts in the field
- · Ability to handle confidential information with discretion
- · Ability to use a personal computer (Microsoft Office, Excel, PowerPoint) and cost report preparation software
- · Ability to work independently with light supervision
- · Advanced knowledge of third party reimbursement payment mechanisms and settlement procedures
- Analyze, interpret and implement government regulatory agency and third-party payer policy and regulations
- Prepare the schedules needed for the Medicare Cost Report and the NYS Institutional Cost Report as determined by the Senior Manager, Regulatory Reimbursement
9
Skills For Contracting & Reimbursement Analyst Resume
- As directed by the Senior Manager, Regulatory Reimbursement, collect the data and prepare the schedules needed for any of the following: responses to audit inquiries, Audit Adjustment Appeal Documents, TEFRA Appeal Documents, and Reopening Requests
- Prepare the internal Medicare Cost Report model and NYS Cost Report Step-down model after the filings so that it is available for modeling and data analysis needed throughout the year
- Assist with various aspects of Medicare and Medicaid cost reporting and related activities
- Assist the Senior Manager, Regulatory Reimbursement in the preparation of special projects required by senior management related to governmental reimbursement
- Perform all other designated assignments as required by the position or as established by the Senior Director, Financial Analysis and/or the Senior Manager, Regulatory Reimbursement
- Excel skills with a working knowledge of advanced table and graph/charting functions
- Experience with SQL, T-SQL, PL-SQL, SSIS, SSRS
- Experience with Indexes, Triggers and Keys
10
Skills For Reimbursement Analyst Intermediate Resume
- Completes and submits all initial Medicaid out of state enrollment applications from initial application through to approval and assignment of Provider number
- Completes and submits all CMS 855A revisions
- Completes other enrollment forms as required
- Review Medicare and Medicaid developments on an ongoing basis to remain current in the field, and to ensure that the Health System understands the impact of new regulations on its business and takes appropriate action
- Assist management with external audits, help resolves audit issues and responds to inquiries from external auditors, such as Medicare and Medicaid
- Develop and continually improve processes to accomplish the above functions through effective use of information systems and coordination of efforts with other staff, including patient accounting, managed care analysts, registration, care management, and divisional and corporate finance
- Experience with computer applications in a Windows environment with specific emphasis on MS Excel, MS Access, MS Word, and MS Outlook
List of Typical Responsibilities For a Reimbursement Analyst Resume
1
Responsibilities For Senior Reimbursement Analyst Resume
- Excellent communication skills; verbal and written with very strong presentation skills to a wide range of audiences
- Effectively communicate Regulatory changes through professional written and verbal skills
- Strong computer skills are essential. Experience with Microsoft products – Excel, Word, PowerPoint, and Access
- Interpersonal skills necessary to communicate effectively with both internal and external personnel in multiple disciplines, on a variety of complex issues
- Analyze and communicate the relevant evidence effectively to target audiences within the region including publication of research findings
- Effectively work on multiple projects
- Analytical skills to collect pertinent information necessary to evaluate complex problems, formulate sound solutions and implement those solutions
- Use Advanced excel skills to identify areas of opportunity to automate and improve current processes to improve departmental efficiency
- Able to effectively engage in a highly professional manner with C-Suite and all levels of an organization; internally and externally
2
Responsibilities For Provider Reimbursement Analyst Resume
- Work effectively in a matrix work environment and manage multiple deadline driven projects
- Four (4) years of Professional Accounting experience preferably in a health care environment
- Maintains integrity of department databases for reporting and efficient and effective research of past issues, resolutions and reviews performed
- Hospital reimbursement experience required
- Develops effective lines of communication with representatives from the third party payers
- Develop and deliver focused regional masterfiles/value dossier for effective and timely use in countries
- Good knowledge of the application, development and critical assessment of health economic models
3
Responsibilities For Value Based Reimbursement Analyst Resume
- Analyze the test data prior to production data for capitation payments and make recommendations for any adjustments to avoid overpayments to providers
- Strong proficiency in MS Office, including PowerPoint, Excel, Word, and Project
- Epidemiology experience desirable
- Demonstrated ability to read, research, interpret and implement government laws and regulations and changes thereof
- Working knowledge of Quality Payment Programs (i.e., MIPS, Medicaid EHR Incentive)
- Working knowledge of Microsoft Office products especially Excel
4
Responsibilities For Senior Reimbursement Analyst / Umms Resume
- Liaise with payers and providers regarding billing, coding and operations management
- Provide in-service training to internal customer’s e.g sales, to increase awareness and understanding of market issues that impact product success
- Prepares supporting analyses to be used in the preparation of monthly financial statements, including development of the case mix index (CMI)
- Performs daily cash posting reconciliation of third-party carriers including all Medicare, Blue Cross, and Medical Assistance payments
- Maintain continuing education credits for coding, documentation, and reimbursement
- Create custom reports using MS SQL Server, MS Reporting Services, Crystal Reports 2008 and Excel
- Evaluate complex database schemas and query data using advanced T-SQL techniques to support the reporting and application needs of the department
5
Responsibilities For Reimbursement Analyst, Senior Resume
- Works closely with the Provider Credentialing Coordinator to ensure managed care payers providers listings are accurate and current
- Works closely with MercyCare Insurance in the development and loading of fee schedules
- Assist in the development of strategic and tactical plans to support Medtronic in an increasing “economically challenged” market place
- Provide the Director and Managed Care Department feedback regarding payer non-compliance with the terms of hospital contracts
- Responsible for the reconciliation of outstanding deposits to balance financial records with a moderate level of complexity
- Establishes follow-up protocol with payors and networks. Prepares monthly performance statistics regarding appeals and recoveries
- Maintains data elements necessary for filing cost reports in a manner consistent with Medicare requirements
- Perform any pre-billing functions necessary to ensure claim is ready for submission to payer
6
Responsibilities For Underpayment Reimbursement Analyst Resume
- Identify bad debt and contractual allowances with attached documentation supporting request for write-offs
- Calculate accurate contractual write off on open accounts, utilizing appropriate write off codes
- Timely follow up on open balance accounts, utilizing "Reminder" system tool on previously contacted accounts
- Respond to patient inquiries regarding account a status within 24 hours
- Develop complex financial models and analyze multiple sources of data impacting the reimbursement of UMMS facilities
- Use logic and reasoning to identify strengths and weaknesses of alternative solutions, conclusions or approaches to problems
- Assists in the preparation, processing, research and analysis of Medicare, Medicaid, and Blue Cross cost reports in compliance with third party regulations
- Knowledge of CPT, ICD-9, HCPCS coding structures
7
Responsibilities For ESC Ops NAM Expense Reimbursement Analyst Resume
- Knowledge of CPT coding desirable
- Proficiency with spreadsheet software (MS Excel)
- Assists in preparation, evaluation and maintenance of processes in support of regulatory and third party updates including quarterly work papers, annual audits, cost accounting and third part cost reporting
- Leads the process to provide therapy and product-specific support and analysis to the field in the areas of US reimbursement rules and regulations for commercially released products in CRHF. Maintain a comprehensive knowledge of the rules and regulations of CMS as well as major commercial payers
- Perform environmental scanning for a well-defined set of topics pertinent to CRHF diseases, therapies and diagnostic investments and potential future ventures to identify competitive products, environmental changes or trends to support field and BU reimbursement intelligence and strategic and tactical planning
- Partner with other team members and the US Regional Economic Managers on critical coding, coverage and payment hospital focused messages and development of tools and customer resources
- Contribute to the process for developing new concepts and innovative ways to educate and deliver timely and relevant reimbursement education materials and collaterals and conducting web based training as part of formal and informal knowledge sharing forums
8
Responsibilities For Reimbursement Analyst, Assoc Resume
- Contribute to reimbursement education programs to internal and external constituents facilitating knowledge transfer and independence through understanding. These programs can include training, best practice sharing, and delivery and sharing of reimbursement expertise and knowledge
- Serve as the point of contact and bring experience in supporting clinical trial agreement negotiations and in determination of standard of care and protocol induced procedures
- Contribute to and project manage cross-functional projects such as Web Ex and education management, Medtronic apps and coverage policy management
- Analyzes, evaluates and interprets data, processes, systems, policies, regulations and internal controls. Conducts impact analyses and modeling, assesses trends, identifies risks, develops projections, determines opportunities and prepares detailed written summaries for management review and decision-making
- Utilizes integrated financial systems, relational databases, business intelligence and desktop analytical reporting tools to access data, develop detailed standard and ad-hoc reports and summaries in order to support department and URO projects and initiatives
- Participates in and serves as a subject matter resource in the development of process improvement initiatives which support business needs and enhance the performance of an operational area of revenue management
- Participates in defining project plans and goals; manages and/or leads small projects or portions of projects with limited impact. Performs business case ROI, conducts business workflow mapping, impact analysis, applies actions steps, provides routine status reports and keeps management apprised ensuring project plans and deliverables are met
- Assists in identifying operational and financial metrics and provides appropriate interpretation and application of data. Designs, develops, implements and maintains systems that provide financial, statistical and operational information
- Interfaces with internal management, leaders, MO staff and stakeholders. Serves as a Subject Matter Expert (SME) and resource possessing the latitude to gather and exchange information and providing guidance and problem resolution on complex, challenging and variable situations that demand deep analytical, interpretive and evaluative thinking
9
Responsibilities For Contracting & Reimbursement Analyst Resume
- Works with the Director of Managed Care Contracting, and partners in Finance, MercyCare and Patient Accounts to stay informed on operational issues impacting contracting strategies
- Researches contracting and payment issues and interacts with payers as a part of that process
- Prepares financial reviews on managed care contracts
- Develops and maintains Managed Care Contract Summary as the master document for partners in Patient Accounts to reference with any questions or other info needed on a particular payer
- Monitors payment accuracy from government payers, such as billed DRG versus paid DRG, appropriate APC or APPL reimbursement. Works with Medical Records or Chargemaster Coordinator to ensure accuracy in the charge master and coding as it impacts reimbursement
- Communicates well with people who are more experienced
10
Responsibilities For Reimbursement Analyst Intermediate Resume
- Maintains in depth knowledge on source data systems and their interaction with medical claims and managed care contracts
- Disseminates information on contracts to all revenue cycle partners, researches issues and strategies for various areas of the revenue cycle team
- Prepares acute and other federal and state cost reports and maintains all related documentation
- Assists with cost report audits and settlements
- Monitors third party payments for legal, regulatory, and contractual compliance
- Works with Patient Financial Services to ensure proper reimbursement rates are loaded accurately and timely
- Develop and implement health economics and reimbursement strategies and tactics to secure optimum reimbursement for Medtronic products
- Identify market opportunities for Medtronic products
- Collaborate with field management to strategically apply Reimbursement and Economic solutions for specific regional customers
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