Posted

30+ days ago

Location

New York, NY

Description

+ Requisition no: 510728


+ Work Type: Full Time


+ Location: Campus|Other US Locations


+ School/Department: null


+ Categories: General Administration


+ Job Type: Officer of Administration

+ Regular/Temporary: Regular

+ Hours Per Week: 35


Position Summary


The Revenue Cycle Junior Analyst (Underpayments) is responsible for identifying reimbursement discrepancies, resolving root cause and submitting appeals to insurance carriers for correct payment. The Junior Revenue Cycle Analyst will provide analytic support, problem solving and communication with Healthcare payers, clinical departments, contracting office and other management.


Responsibilities


+ Reviews paid claims to identify instances of under payments in accordance with contracted reimbursement.

+ Reviews and analyzes “Explanation of Benefits” (EOBs) to identify under-allowed claims.

+ Utilize contract management tools such as Experian to identify under-allowed claims for bulk appeals.

+ Uses feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals.

+ Compiles and batches appeals by payer, issue, or other pertinent criteria for expedited re-processing of claims.

+ Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to management team.

+ Prepares monthly performance statistics regarding appeals and recoveries. Perform analysis and identify corrective action plans to address root issues.

+ Performs routine follow-up and escalate as required.

+ Validates findings of underpayment to confirm provider and location credentialing.

+ Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages and verifying member information for managed care plans.

+ Provides feedback to CRO management and Departments in the coordination of projects and activities.

+ Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts.

+ Participates in professional development efforts to be current in managed care reimbursement trends.

+ Keeps apprised of rules and regulations affecting reimbursement. Stays current through appropriate journals and personal contacts of such developments in the industry as may increase the effectiveness of operations.

+ Partners with fellow colleagues to support each other in their work to contribute to overall unit success.

+ Represents the FPO on committees, task forces and work groups as assigned.

+ Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines.

+ Performs other duties and responsibilities as assigned by the Chief Revenue Cycle Office and Directors of the CRO.


Minimum Qualifications


+ Requires bachelor’s degree or equivalent in education and experience.

+ Minimum of 3 years’ related experience.

+ Demonstrated proficiency in health insurance billing, collections, and eligibility as it pertains to commercial and managed care, and self-pay reimbursement concepts.

+ Demonstrated strong skills in problem assessment, and resolution and collaborative problem solving in complex, interdisciplinary settings.

+ Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution.

+ Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.

+ Ability to work independently and follow-through and handle multiple tasks simultaneously.

+ Excellent verbal and written communication skills.

+ Intermediate level proficiency of Microsoft Office (Word & Excel) or similar software is required and an ability and willingness to learn new systems and programs.

+ Must be a motivated individual with a positive and exceptional work ethic.

+ Must successfully complete systems training requirements.


Preferred Qualifications


+ Knowledge of Experian contract management software, Epic, IDX is preferred.


Other Requirements


Core Competencies


Accountability & Self-Management


Level 3 - Intermediate


Adaptability to Change


Level 3 - Intermediate


Communication


Level 3 - Intermediate


Customer Service-Patient Focus


Level 3 - Intermediate


Emotional Intelligence


Level 3 - Intermediate


Problem Solving & Decision Making


Level 3 - Intermediate


Productivity & Time Management


Level 3 - Intermediate


Teamwork & Collaboration


Level 3 - Intermediate


Quality & Compliance Focused


Level 3 - Intermediate


Leadership Competencies


Business Acumen & Vision Driver


Level 1 -Introductory


Performance Management


-


Innovation & Organizational Development


Level 1 -Introductory


Equal Opportunity Employer / Disability / Veteran


Columbia University is committed to the hiring of qualified local residents.