The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Job Summary
The Reimbursement Analyst analyzes and manages revenue cycle data related to third-party reimbursements, ensuring accuracy and compliance with regulations as well as assists with many other areas in revenue cycle. This role involves preparing reports, calculating revenues, and resolving billing issues, while also contributing to process improvements and maintaining strong communication with various stakeholders. The Analyst is responsible for identifying payer accounts to determine compliance with payer contracts. They will audit these accounts and follow up with payers on resolution on reimbursement discrepancies. This position will play a key role in departmental projects pertaining to revenue cycle process improvement. This is a hybrid work position.

Essential Functions
Supports all revenue enhancements initiatives as needed. Utilizes Contract Management Variance Report to identify those accounts that have not paid in accordance with the contract. Pursues underpayment disputes until final resolution and works to improve processes that results in underpayments and/or denials. Researches discrepancies and performs follow-up as needed with plans and internal departments such as billing, UM and coding. Materially participates in various department and company-wide meetings and efficiency improvement projects. Supports the Revenue Integrity office and other leaders in performing payer research and recommend payer initiatives to address problem payers. Supports the Revenue Integrity office in managing work queues timely and assisting in projects as needed. Attends payer webinars and other online educational opportunities as appropriate. Must be able to stay updated and educated on changes occurring in healthcare industry. Compiles and analyzes data related to net revenue and other reimbursement projects. Generates reports on reimbursement trends and identifying areas for potential improvement. Provides necessary support to all internal and external customers in an accurate a timely manner. Assist in documentation of department policy and procedures for Revenue Cycle. Meets with all levels of management to review Revenue Cycle data. Analyze audit findings, educate and share information along with coordinating process improvements with the individual departments as they relate to hospital operations. Supports Team by cross training or providing back-up coverage as needed. Serves as primary contact with all contracted payers for claims related issues and manages Joint Operating Committees with payers. Uses system EHR competently to perform all necessary job functions. Uses Microsoft Office, as necessary for all job functions. Complies with all SRH policies and procedures. Complete all mandatory learning requirements in a timely manner. Attend and actively participate in all department, team and/or committee meetings. Perform other duties as assigned by Director, Manager or designee. Knowledge of Medicare and Managed Care reimbursement.

Education
Graduate of an accredited four-year college or university with work in accounting, business administration or related field preferred (related work experience may be adequate).

Experience/Training
Minimum three years of relevant experience in the healthcare reimbursement, payer contracting, finance, or billing field.
Knowledge and understanding of healthcare reimbursement. Knowledge and understanding of Medicare and WA State Medicaid rules and regulations affecting healthcare reimbursement. Knowledge of MS-DRG, APR-DRG, CPT, RVU, EAPG and APC reimbursement methodologies. History of effectively interpreting payer contracts and reimbursement policies. Understanding of Medicare, Medicaid, and other third party payer appeals processes. Knowledge of contractual allowance and third party settlement processes. Knowledge of hospital/patient accounting systems and processes. Ability to use essential applications and/or databases associated with the role’s duties and responsibilities. Hospital and clinic experience strongly preferred. Proficiency in Microsoft Excel and EPIC EHR experience preferred.

License/Certifications

Other Skills
Excellent verbal, written and interpersonal communication skills. Analytical skills to recognize, research and resolve questionable data. Must present a professional demeanor and encourage participation and collaboration in an open approachable style with all customers. Proactive, highly organized, and detail oriented. Proven history of working effectively under time constraints while managing multiple projects simultaneously. Ability to work independently and as part of a team. Ability to prioritize workload to complete assignments accurately and timely to meet deadlines. Demonstrates initiative in providing feedback/input to improve workflow. Ability to work effectively in a dynamic and fast-paced environment with changing business priorities.

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the days is function of the position. Specific vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.

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Job Type: Full-time

Pay: $28.36 - $42.54 per hour

Work Location: In person

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Reimbursement Analyst

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