Payment Validation Analyst

This is a fully remote position, open to applicants in Alabama, +15 more states.

📋 Description

• Examine contractual underpayments and address daily issues within Epic work queues

• Determine root causes and implement necessary corrective measures

• Address pricing and contract inconsistencies in Epic work queues

• Collaborate with CDM Analysts and Revenue Integrity Analysts to execute fee schedule adjustments

• Conduct rebill projects aimed at recovering underpayments

• Act as a subject matter expert regarding payer reimbursements and contracts

• Investigate non-covered and denied charges and assist the Revenue Integrity Manager with appeal processes

• Identify issues or trends in coding, charging, and billing that lead to inaccurate payments

• Educate relevant staff and oversee rebilled accounts to ensure appropriate payment

• Generate monthly measurement reports utilizing Epic reports, including findings, follow-up actions, and proposals that require director approval

• Establish and manage contracts within Epic

• Support new program launches and identify reimbursable services that have not been coded or charged

• Investigate and resolve issues related to CPT codes, revenue codes, and charge master

• Coordinate routine individual projects through effective planning and organization of project steps

• Utilize logical sequential steps and flowchart techniques with minimal guidance

• Perform additional tasks as assigned

⛳️ Requirements

• Bachelor's Degree - Required

• High School Diploma - Required

• At least five years of experience and knowledge of hospital financial operations, including reimbursement, Medical Billing, Charge Master Development and Maintenance, Medical Records/Coding, and Charge Audit experience - Required

• Comprehensive understanding of hospital financial operations including reimbursement, coding, and charge master development and maintenance - Required

• Extensive knowledge of CPTs, HCPCs, and ICD-10 medical coding, along with related APC Medicare reimbursement - Required

• Proficiency in data entry, typing, using a calculator and small business equipment, communicating clearly and professionally, answering phones, and performing copying tasks

• Strong oral and written communication skills with staff, leadership, physicians, and consultants, both individually and in team settings

• Ability to analyze, synthesize, evaluate, comprehend, explain, forecast, interpret, manipulate numbers, interpret data, calculate, organize, plan, and present to both small and large groups

• Highly energetic, self-motivated individual

• Capability to identify areas of concern

• Accuracy is crucial 95% of the time

• Maintaining confidentiality is essential 100% of the time

• Travel to off-site locations may be necessary - Required

• Epic Contracts Module Certification - Preferred Upon Hire

🏝️ Benefits

• Concierge services

• Employee lounge

• Wellness programs

• Free covered parking

• Free on-site and virtual health clinics

• Compensation and recognition programs