Revenue Cycle Analyst, Payor Knowledge

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Oversee the management of the contract management tool, Rivet.

• Supervise SHM Revenue Cycle fee-related tablespaces.

• Assist in prioritizing and executing system changes and updates.

• Resolve issues and respond to inquiries from end users.

• Coordinate and engage in project task deliverables.

• Prepare for and participate in meetings with payers.

• Review, analyze, extract, and organize critical information from payer contracts and amendments into the Payer Contract Matrix.

• Develop, maintain, and verify fee schedules based on contract payment sources and reimbursement rates.

• Analyze reimbursement data to detect discrepancies, payer trends, and opportunities to enhance reimbursement.

• Investigate payer contract documentation and payer websites to ensure compliance and reimbursement integrity.

• Share identified opportunities and trends with internal and external stakeholders, supported by data.

• Generate reports for RCM team members to assess unfavorable claim outcomes, seek recovery of underpayments, or submit corrected claims.

• Establish contact with payers to confirm contracted rate discrepancies.

• Collaborate with the Payor Knowledge team to address fee schedule errors, load new codes, and map payers.

• Work with product and technology teams to create new technology solutions or improve existing software.

• Prepare client-facing reports and special projects related to contracts and fee schedules, including Charge Master Analysis, Quarterly Payer Scorecard Reports, Claim Analysis Reports, and Underbilling Alerts.

⛳️ Requirements

• Strong analytical abilities to reconstruct multi-step processes and rectify sources of error.

• In-depth knowledge of Revenue Cycle applications, including updates and enhancements.

• Basic understanding of medical billing, encompassing charge entry, EOB/remittance review, payment posting, and reconciliation practices.

• Exceptional verbal and interpersonal communication skills, capable of clearly articulating problems, solutions, and changes.

• Proficient with computer systems and quick to adapt to new programs and websites.

• Ability to interpret contract language and manage updates to the contract database.

• Advanced analytical and research skills, with a keen attention to detail and the capability to manage multiple complex contracts simultaneously.

• Familiarity with various practice billing software systems, including comprehension of workflows, processes, and billing procedures.

• Knowledge of clinic, provider groups, and hospital revenue cycles, as well as insurance payment methodologies.

• Expertise in payer contracts, types of insurance, and associated billing and reimbursement policies.

• Capability to manage responsibilities related to payer contracts, fee schedules, and analysis across multiple business units.

• Understanding of state, federal, and commercial payer reimbursement rules, policies, and methodologies.

• Industry certifications (e.g., CSPR, CRCR, CHAM, CHFP, FHFMA, FACHE) are advantageous.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Life coverage.

• Disability coverage.

• Vision coverage.

• FSA coverage.

• 401k savings plan.