Financial Reimbursement Specialist - WMCHealth : Job Details

Job Summary:

The Financial Reimbursement Specialist is responsible for providing systems applications and maintenance support to end users in Revenue Integrity and Patient Accounts department for Siemens Contract Management system (SCM). Responsibility involves performing complex financial analysis using SCM to calculate and project revenue and utilization for Hospital services. Other responsibilities would include monitoring hospital in-patient and out-patient payments and identify payment discrepancies. Coordinates system issues with IT or Siemens directly as required. Performs other related work as required.

Responsibilities:

• Responsible for maintaining managed care contracts in contract management system including reimbursement formulas/calculations in accordance with payment methodology (DRG, Medicare/Medicaid, Managed Care - Commercial, etc,). Validates payment rate calculations and prepares queries and reports from application systems as required.
• Conducts payment discrepancy analysis comparing expected to actual payments utilized for obtaining correct cash payments including re-billing managed care carriers and measurement performance.
• Use various reporting tools to perform contract error analysis and classify WMC patient population for accurate reimbursement.
• Applies third party methodologies to SCM in order to analyze profitability of the various reimbursement methodologies.
• Uses computer applications or other automated systems such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments.
• Helps troubleshoot departmental application system problems and assists in resolving these problems under the technical direction of Information Technology staff and Senior Director-Managed Care.
• Writes and maintains reimbursement formulas/calculations based upon managed care or third party agreements including user notes and other custom documentation about departmental systems and expected output for the contract management system and for financial analyses.
• Works with Information Technology staff to coordinate hardware and software installations; assist in long and short term planning needs, new initiatives and/or the modification of application software.
• Provides technical support for department to produce profit(loss) analysis by service and by physician.
• May access protected health information (PHI) in accordance with departmental assignments and guidelines defining levels of access (i.e. incidental vs. extensive).
• May perform other incidental tasks, as needed.

Experience:

2-3 years of experience working with reimbursement methodologies (DRG's, managed care, medicare, etc.) for a managed care organization, health care consulting firm, or in a hospital division of Finance, Reimbursement or Patient Accounts.

Education:

Bachelor's Degree in Finance, Business Administration or a closely related field, required. A Master's Degree in Finance, Health or Hospital Administration may be substituted for one year or the above experience.

Licenses / Certifications:

Other:

Good knowledge of the principles and practices of hospital administration; good knowledge of reimbursement methodologies, including Diagnostic Related Groups (DRG's) as defined by Medicare and New York State; ability to perform analytical reviews of rates in order to ascertain their implications for hospital; ability to learn and efficiently load managed care rates into SCM; ability to deal effectively with a wide range of professional, administrative, technical and clerical personnel; ability to communicate effectively both orally and in writing; good knowledge and ability to use Windows based office software; sound and mature judgment; good knowledge of win. Special Requirements: Advanced user of Microsoft Office products. Extensive knowledge in support of business critical systems, including such technical areas as PC equipment, PC operating systems, and their functional capabilities; ability to analyze and understand organizational structure, functions, operations, goals and objectives in support of the installation of application and office software.

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

• Health Insurance
• Dental
• Vision
• Retirement Savings Plan
• Flexible Savings Account
• Paid Time Off
• Holidays
• Tuition Reimbursement