Description
The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans
The Reimbursement Analyst supports reimbursement efforts with the Associate Director of Revenue Integrity. This position will assist/process Craneware software to ensure pricing strategy is optimal; manage complex reimbursement processes to ensure accuracy of data; maintain up-to-date knowledge of healthcare billing and coding regulations; track and monitor claims to ensure timely reimbursement from insurance companies.
Responsibilities
- Manage complex reimbursement processes to ensure accuracy of data.
- Maintain up-to-date knowledge of healthcare billing and coding regulations.
- Understand/process and review all data provided by Craneware.
- Track and monitor claims to ensure timely reimbursement from insurance companies.
- Work closely with AD of CDM to ensure that CDM is up to date and supporting optimal reimbursement.
- Be subject expert on reimbursement for clinical staff. Maintain availability to research new codes established for reimbursement.
- Follow new codes in use to collection end to ensure codes paid as anticipated.
- Maintain availability to run reimbursement reports for analyzing with Service Lines regarding reimbursement.
- Remain current on changes in healthcare reimbursement regulations and procedures.
- Communicate effectively with other staff members, insurance companies, and patients.
- Resolve complex reimbursement issues in a timely manner.
- Ensure that price structures for both hospital and professional charges are reviewed and analyzed for optimal reimbursement annually.
- Work closely with Denial Prevention Team to ensure denials are not a result of set up and to review other reimbursement options.
- Ensure clinical staff are aware of situations where optimal reimbursement is not occurring.
- Perform other duties as assigned.
Qualifications
Minimum Qualifications
- Bachelor's degree in computer science, accounting, information services or related field plus 3-4 years of experience providing consultation, reporting, analysis, and/or dashboard development for revenue focused departments/service lines in a healthcare provider setting or equivalent education and experience.
- Proficient computer skills; MS Office including Word, PowerPoint, Excel, and Outlook; Windows operating system and internet.
- Experience and proven success in practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
- Proficiencies – Advanced knowledge of revenue cycle processes and hospital/professional billing to include CDM, UB04, Remittance Advices and 1500 claim form. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement methodologies to include DRG, OPPS, professional and facility billing. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
- Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical thinking and the ability to meet deadlines while influencing, but not directly managing the work of others.
Preferred Qualifications
- Understanding of CPT/HCPCS codes, payer regulations and payer reimbursement.
- Data Visualization experience utilizing Power BI.
- Working knowledge of Epic HB Resolute and PB Resolute.
- Working knowledge of Epic Slicer Dicer.
