Reimbursement Analyst

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.

It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community.

Benefits Eligible

Full-Time Benefit Eligible

Work Shift

Day - 8 Hour or less Shift (United States of America)

Department

8513 Finance-Managed Care Svcs

Maintains complete and full knowledge of all payer(s) to ensure accurate collection of the claims. Validates that the Kaweah Health is being reimbursed by the payer in accordance with government or contract terms.

QUALIFICATIONS

Experience
Required: Minimum of two years experience working in areas of managed care or hospital billing. Experience in healthcare related field.
Knowledge/Skills/Abilities
Firm understanding of institutional claims adjudication, managed care reimbursement methodologies such as DRG, APC, per diem, stop loss, SNF RUGS, case rates, home health etc. and CPT and ICD-9 coding.
Proficient in personal computer software applications, Microsoft Excel and Microsoft Word.
High motivation and self-direction and the ability to develop skills to communicate and convey complex information to various audiences within the organization.
Working knowledge of Invision system preferred.

JOB RESPONSIBILITIES
Essential
Audits, reviews, tracks and reconciles all denials or claims paid incorrectly due to contractual issues.
Pursues underpayment disputes until final resolution.
Attends payer in-service, webinars, etc. and serves as a subject matter expert.
Supports departments with contractual reimbursement through training, problem solving and other guidance.
Supports departments with denial management through training, problem solving and other guidance.
Researches discrepancies and performs follow-up as needed with plans and internal departments such as patient accounting, UM and management.
Reviews all large dollar claims and works with appropriate staff and departments to ensure accurate billing, coding and charge integrity.
Oversees and assists Denials Management.
Provides detailed analysis and recommendations of payer specific denials to Patient Accounting and the Managed Care Department.
Researches patient specific problems on an as needed basis.
Provides Patient Accounting and Managed Care Manager detailed reports of all contractual underpayments, denials and collections.
Keeps a good working relationship with other departments within the Kaweah Health.
Maintains confidentiality of company, client and patient information.
Reviews the Contract Management Variance report to identify those accounts that have not been paid in accordance with our contract.
Supports supervisors in performing payer research and recommend payer initiatives to address problem payers.
Examines and quantifies financial impact of payment problems and reimbursement discrepancies.
Works with Patient Accounting and Managed Care Department to identify and research sources of delays, denials and underpayment patterns from Managed Care payers.
Adheres to all HIPAA rules and guidelines for patient confidentiality.
Works with Patient Accounting and other departments as necessary to determine ways to improve payment problems as well as billing and collection problems.
Additional
Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.
Performs other duties as assigned.

Pay Range

$20.78 -$31.17

If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.