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Reimbursement AnalystJob ID 141232 Date posted 04/22/2018
Position Summary: Reporting to the Manager of Revenue Finance this position participates in a wide variety of tasks in support of Lahey Health hospitals and physician groups third party reimbursement efforts. Utilizing the contract management technical and professional systems to appeal and resolve payment variances. Meet with insurance provider representatives to communicate reimbursement issues and resolve payment variances. Communicates reimbursement issues and trends to management.
Essential Duties & Responsibilities including but not limited to:
1) Utilizing the contract management system reports, identifies inappropriate payments from the various payers.
2) Writes appeal letters and creates corrected claims to recover payments on underpaid claims.
3) Understands and utilizes standard and ad hoc reports from a wide variety of systems to identify, analyze, appeal, track and follow up on incorrectly reimbursed claims.
4) Reviews and approves refund requests received from a variety of internal and external sources.
5) Tracks and trends denials and underpayments by adding user codes in the contract management systems in order to communicate with management.
6) Audits new contracts and term updates for accuracy.
7) Participates in and completes projects as assigned by manager.
8) Attends meetings as required.
9) Maintains strict adherence to the Lahey Clinic Confidentiality policy.
10) Incorporates Lahey Health Guiding Principles , Mission Statement and Goals into daily activities.
11) Complies with all Lahey Clinic Policies.
12) Complies with behavioral expectations of the department and Lahey Clinic.
13) Maintains courteous and effective interactions with colleagues and patients.
14) Demonstrates an understanding of the job description, performance expectations, and competency assessment.
15) Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
16) Participates in departmental and/or interdepartmental quality improvement activities.
17) Participates in and successfully completes Mandatory Education.
18) Performs all other duties as needed or directed to meet the needs of the department.
Education: Bachelors degree in Health Care Management, Business Administration or Accounting or a combination of education and relevant billing or contract management experience
Licensure, Certification, Registration: None
Skills, Knowledge & Abilities:
Strong organizational and communication skills
Working knowledge of various code sets including revenue codes, HCPCs, CPT, modifiers,ICD10 procedure codes, DRGs and APC/APG coding
MS Office applications, particularly excel experience
Ability to think creatively and work independently
Ability to work well with others
One to Three years of experience working with a contract management system or direct third party billing experience
Working knowledge of technical and/or professional third party billing and reimbursement methodologies
Experience with technical and/or professional billing systems, EPIC experience a plus
About Lahey Health
The Lahey Model of Care?right care, right time, right place?is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.
How To Apply
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