Catholic Health Initiatives Reimbursement Specialist - Payer Contracting Compliance - Mercy Health Network in DES MOINES, Iowa
Reimbursement Specialist - Payer Contracting Compliance - Mercy Health Network
Job Summary / Purpose
The Reimbursement Specialist is responsible for maintaining, researching and resolving reimbursement issues related to contracts between MHN providers and managed care payers or third party payers. Supports the enforcement of payer contracting terms associated to payment performance of such payers.
Essential Key Job Responsibilities
Researches and resolves reimbursement variances between payments received and expected allowances to ensure payments are within contract guidelines.
Requests additional payment from payer when necessary.
Researches payer specific policies to determine coding/claims submission requirements and associated reimbursement
Monitors payer specific changes in claims submission requirements and provides routine updates to MBO and RCM Vendor
Acts as a contracting compliance liaison between MBO and RCM vendor to coordinate and escalate payer related issues
Collects and summarizes reports for leadership including contract terms and monthly accomplishments including post pay audit findings, and additional reimbursement as a result of escalation efforts
Maintains the ability to understand and utilize a complex and highly sophisticated billing system
Non-essential Job Responsibilities
- Other duties as assigned by management
Required Education for CHI Leadership Job Levels
(from Supervisor through President)
Required Education for Staff Job Levels
Required Licensure and Certifications
Required Minimum Experience
6 mos. – 2yrs hospital/clinic business office experience required.
Minimum of three (3) years hospital or physician/professional billing or business office experience required if no specialized medical office training.
Background in financial healthcare reimbursement analysis is required, including an understanding of diagnosis and procedure coding, billing practices, and payment methodologies. Managed care knowledge preferred.
Prior experience in working with insurance payer reimbursement policies and/or contracts preferred
Required Minimum Knowledge, Skills and Abilities
Health care systems and inter/intra-relationships;
Hospital finance, revenue cycle, and information systems;
Complex managed care concepts and processes;
Health insurance pricing and associated benefit designs
Provider billing and claims processing
Strong skills in statistical analysis
Strong microcomputers (including spreadsheet, database, and word processing software);
Strong written and verbal communication;
Management and interpretation of data;
Analyze and problem solve;
Coordinate to engage people and technology and lead projects from beginning to end;
Read an interpret contract language and reimbursement mechanisms;
Develop positive working relationships with senior management, physicians, hospital staff, and managed care company representatives;
Communicate effectively with all levels of staff and customers;
Demonstrate high level of self-directed motivation; professionalism; and trust;
Handle multiple tasks on a daily basis.
PREFERRED Education and/or Experience
High School graduate plus medical office training education required
Two year degree in business or related healthcare field preferred
Job Professional Non-Clinical
Primary Location IOWA-DES MOINES-MERCY MEDICAL CENTER
Daily Schedule Days
Scheduled Hours per 2-week Pay Period 80
Weekends Required None
Req ID: 2018-R0162615
We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.