Reimbursement Analyst - Payer Analytics

Job Summary and Responsibilities

This position coordinates, monitors and reports on multiple business office operations and revenue cycle work teams for primary care, specialty and hospital based clinics including the billing and collection of patient accounts, preparation/submission of insurance claims, cash applications, billing compliance, implementation of best practices, third-party contracting arrangements, and all related customer service and support activitiesThe incumbent ensures the effectiveness and quality of billing functions and systems provide for accurate reimbursement, maximum cash flow, timely and effective customer service for all providers and clinics. Is primary liaison with division resources for insurance billing and follow-up, account maintenance, accounts receivable/payable activities.Advises on change management processes for business office functions during redesign and system conversions, identifying key staff to support/lead implementation and change processes. Consistently open to change and improvements in billing office. Serves as implementation champion for needed changes with staff and customers. Responsible for ensuring all billing office policies, procedures and standards are appropriate, compliant and updated timely. Communicates policy, procedure and standard changes to providers, clinics and staff effectively and through multiple approaches, as needed.Responsible for ongoing education of physicians, clinics and staff on updates/changes to procedures regarding business office functions. Responsible for oversight of the practice management system functions including claims edit, and electronic payment transmission information system master tables in conjunction with the information services department, to ensure accurate and timely claims submission, payment posting, collections & follow-up. Manages relationship, contract, fees and performance expectations with third party collection agencies and billing services. Responsible for ensuring the accuracy and integrity of the practice management system in conjunction with the coding department relative to regulatory requirements such as Medicare Fraud Initiatives specific to bundling and unbundling codes, billing unchargeable items, and billing non-covered services. Keeps abreast of applicable statutory limitations, rules, regulations, standards and emerging trends impacting healthcare business office operations; ensures that regulatory updates are integrated into daily operations.

• Supports CommonSpirit Health’s mission to make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. Follows the policies and procedures of the organization.
• Adheres to the Corporate Compliance Program, including confidentiality of HIPAA protected health information.
• Creates system of reports and dashboards to inform leadership regarding revenue cycle performance across the Medical Group and at a clinic level. Works with managers to address areas of opportunity for improvement.
• Serves as a liaison between division revenue cycle resources, IT personnel, system maintenance specialist, management and end users to resolve questions related to system functionality and design.
• Serves as primary resource for revenue cycle system and payer updates, maintenance and data integrity.
• Assesses end user needs and recommends modifications. Recommends and documents procedural changes. Makes and implements recommendations for changes and enhancements to system.

Job Requirements

Required

• Bachelors Other Business or related area or Five or more years’ of related experience, upon hire and
• Five years of experience using complex computer software systems for revenue cycle and finance applications., upon hire and
• Experience as a front line user and intermediary to other departments or vendors in one or more of the following applications, upon hire
• None, upon hire

 

Where You’ll Work

Welcome to CHI Saint Joseph Medical Group, a full service network of primary care services specializing in family, internal, geriatric and pediatric care serving 88 locations across central and Eastern Kentucky. CHI Saint Joseph Medical Group is dedicated to delivering customized care based on the unique needs of our patients and is recognized as a Best Place to Work in Kentucky for two years in a row (2023-2024). 

 

CHI Saint Joseph Health is part of CommonSpirit Health, a non-profit, Catholic health system dedicated to advancing health for all people. With approximately 175,000 team members and 25,000 physicians and advanced practice clinicians. 

 

Our commitment to serve the common good is delivered through the dedicated work of thousands of physicians, advanced practice clinicians, nurses, and staff; through clinical excellence delivered across a system of 140 hospitals and more than 2,200 care centers serving 24 states.