Job Summary
Under the direction of the A/R Supervisor, The Contract Management Analyst will review and analyze all variances and determine corrective action. Responsible for analyzing payments received from third party payers. Researching and correcting any under or over payments per the established payer contracts. The Contract Management Analyst functions as a billing liaison to patients, providers, and insurance carriers, internal and external customers to ensure appropriate reimbursement on claims.
Duties & Responsibilities
- Review variances and follow up on remaining balance that is due. Establish follow up protocol to initiate claim adjustment for additional reimbursement.
- Review variances and proceed with overpayment recovery process to ensure that accounts that are overpaid are recouped/ refunded in a timely manner by the third party payer.
- Utilizes information system tools to document, report and analyze the accounts receivable.
- Initiate corrected claims as necessary to resolve under or over paid accounts.
- Provide supporting documentation as needed to appeal variances in a timely manner.
- Initiate adjustment requests to rectify false variances in the contract management system.
- Analyze payment discrepancies and determine the root cause by payer, facility coding or system setup and inform supervisor to escalate as needed.
- Demonstrates knowledge of accounts receivable payment policies and hospital contracts as they relate to billing, collection, follow-up, claim reimbursement, patient liability, and local, state and federal programs.
- Accurately documents account history in appropriate computer systems within defined time frames in accordance with department policies and procedures.
- Respond to email, telephone calls and other correspondence on a daily basis in accordance with department policy and procedures.
- Preserves and protects patient s rights to confidentiality.
- Performs other related duties as requested.
Requirements
- High school degree required.
- Associates degree preferred.
- Minimum of 3-5 years of previous experience in a healthcare or business environment.
- Excellent human relations, communication, and organizational skills required.
- Working knowledge of computer applications, including word processing, spreadsheet, and database applications required.
- Knowledge of third party payers and collection policies and procedures required.
- Excellent analytical, oral and written skills with the knowledge and ability to communicate and collaborate with agencies and internal and external customers required.
About Us
Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation's top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.
EEO Statements
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.
- High school degree required.
- Associates degree preferred.
- Minimum of 3-5 years of previous experience in a healthcare or business environment.
- Excellent human relations, communication, and organizational skills required.
- Working knowledge of computer applications, including word processing, spreadsheet, and database applications required.
- Knowledge of third party payers and collection policies and procedures required.
- Excellent analytical, oral and written skills with the knowledge and ability to communicate and collaborate with agencies and internal and external customers required.
- Review variances and follow up on remaining balance that is due. Establish follow up protocol to initiate claim adjustment for additional reimbursement.
- Review variances and proceed with overpayment recovery process to ensure that accounts that are overpaid are recouped/ refunded in a timely manner by the third party payer.
- Utilizes information system tools to document, report and analyze the accounts receivable.
- Initiate corrected claims as necessary to resolve under or over paid accounts.
- Provide supporting documentation as needed to appeal variances in a timely manner.
- Initiate adjustment requests to rectify false variances in the contract management system.
- Analyze payment discrepancies and determine the root cause by payer, facility coding or system setup and inform supervisor to escalate as needed.
- Demonstrates knowledge of accounts receivable payment policies and hospital contracts as they relate to billing, collection, follow-up, claim reimbursement, patient liability, and local, state and federal programs.
- Accurately documents account history in appropriate computer systems within defined time frames in accordance with department policies and procedures.
- Respond to email, telephone calls and other correspondence on a daily basis in accordance with department policy and procedures.
- Preserves and protects patient s rights to confidentiality.
- Performs other related duties as requested.